Health Insurance 44

[tbonebanjo]

I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way?

 

[JohnRBaker]

I don't recall the debate the way you do. I don't recall any Republican input--

Perhaps you read too many Newsweek articles or listened to too many FauxNews reports, but the facts were quite different. For example, here an excerpt from the linked item below:

"Almost no one is noting the extraordinary influence Republicans had on the healthcare reform bill crafted by the Senate, as it made its way through the committee process last year. The bill approved by Sen. Christopher Dodd’s Health, Education, Labor and Pensions committee, for instance, included 161 amendments authored by Republicans. Only 49 Republican amendments were rejected out of 210 considered. Yet the bill got zero Republican votes when it passed out of the committee."

And then there was this final recap:

"To recap: Senate Democrats have accepted at least 161 Republican amendments to their healthcare reform legislation, they’ve incorporated core GOP planks, and they’ve scuttled an aspect of the plan most popular with its base, the public option, because of opposition by Republicans as well as red state Democrats.

But they haven’t compromised with Republicans? It seems as though the GOP’s definition of compromise and collaboration involves the president and the Democrats dropping all of their ideas and passing the Republican platform. That’s OK; it’s their job to push their party line. But too much of the media seems to be falling for it."

For the complete article, go to:

http://www.salon.com/2010/02/23/hcr_amendments/

And here's another item that talks about the influence that the Heritage Foundation and previous Republican proposals had on the ACA:

http://www.politifact.com/punditfac...5/ellen-qualls/aca-gop-health-care-plan-1993/

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[beej67]

And where do these costs come from? All universal healthcare systems COST LESS PER CAPTIA than the US system.

I'm not going to type all the same crap all over again. Please re-read the posts made at the following dates/times in this thread by me. Bolded dates are posts that specifically discuss the source of our higher cost per capita, while non-bolded dates are posts that discuss how changing the methodology of cost sharing doesn't affect the problem.

21 Sep 14 20:47

If I get a ear ache in Mexico I go to the pharmacist, buy some amoxil, go home and eat it. My total cost to the system is ten bucks. If I get an ear ache in the US, I have to go to primary care, pay a copay, he bills the insurance company and says "go see an ENT," I go to the ENT, pay another copay, he bills the insurance company again, gives me permission to buy a highly proprietary patented expensive version of amoxil he's on the take to peddle, sends me to the pharmacist, and I pay another copay there while the pharmacist bills the rest of the bill to the health plan.

Unless you blow that completely stupid business model up, health care is going to continue to be completely stupid in the USA. It's got nothing to do with who shares the costs, whether it's public or private. It's got everything to do with the lack of an individual's motivation to keep their own costs down, and the systems motivation to do everything to drive costs up, since they're billing the shared pool anyway.

23 Sep 14 7:36
23 Sep 14 15:30
25 Sep 14 15:37
8 Oct 14 11:39
17 Oct 14 15:39
19 Oct 14 17:19

The problem is if I sprain my knee in Denmark, I go to the doctor, he sends me home with some pills and an ACE bandage. I sprain my knee in the USA, I go to the doctor, he sends me to a specialist, who sends me to an MRI, which must be read by a specially trained/paid MRI Reading Person, who tells the specialist, who tells the generalist, that I should go home with some pills and a highly specialized proprietary knee brace that does the same thing as an ACE bandage.

21 Oct 14 12:57
21 Oct 14 16:07

When we all used to pay for our own stuff, we had incentive to tell a doctor "no, I really don't need that MRI for five thousand dollars if it's not going to change your recommendation anyway." When we pay into a shared pool, we have every incentive in the world to go get the free MRI that we don't really need, because why not? We've already paid for it. And the doctor has every incentive in the world to recommend the MRI, since we're not going to say no, and he makes more money when we say yes, and in fact he could get sued if he doesn't recommend it.

That's it. That's the deal. The U.S. system is a feedback loop of cost pressures.

21 Oct 14 21:21
28 Oct 14 11:17
30 Oct 14 15:04

Medicare is a single payer here in the USA, and Medicare recipients do not have a lower rate of surgeries than insurance buyers. The payer is not the only difference between England and the USA. The systems themselves are different.

Now, if we go full Communism and not only do single payer, but also single provider, then the rate of surgeries goes down. We have evidence of that. It's called the VA, who let people die because they were lazy and didn't have to compete with private care for the patients dollars. Not even one of the country's most decorated and dedicated Army Generals could steer the VA towards a semblance of respectability.

Much more in the referenced posts. Quoting everything would have been burdensome.



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[cranky108]

beej67, that is correct and why a single payer system will not fit the problem in the US, and is why medical costs are higher.

The issue is that many in congress and the president don't want to fix the system, as it provides a system of control over the people. That's the issue. The food police is just more of that control of it.

Now that the "operation strangle hold" has been open it is even deeper that most of us thought. Gun police, porn police, payday loans police, and what's next?

The medical issues in the US is nothing more that control of the people, and that's why costs are going up. You don't pay enough in taxes is the issue.

 

[rconnor]

beej67,

I fail to see how any of that supports a “free-market” system or provides a rational argument against a universal healthcare system.

Your first example (the ear ache) deals with Mexico, which has universal healthcare. Your second example (sprained knee) deals with Denmark, which has universal healthcare. You seem to be arguing that universal healthcare would be the better option, I don’t disagree.

Your third quote assumes that in a “shared pool” we have no incentive to keep costs down, so costs will be high. This is typical libertarian ideology and, equally typical, is not supported by the data. Universal healthcare is the epitome of a shared pool and yet, in the real world, the costs of operation are very low. Much lower than the US’s mixed system.

Furthermore, I have provided examples as to why the insurance aspect of the US system is where the majority of the increases in cost come from. In a universal healthcare system, these issues disappear as there are no private insurance companies to deal with. I don’t see anything that suggests otherwise from you.

A “free-market” system either has private insurance companies, and then is left with many of the existing issues plaguing the US system, or it doesn’t have private insurance companies (everyone pays out-of-pocket), and then the issues of inequity and lack of available healthcare for the poor become much worse. Correct me if I’m wrong but I don’t see a third option. The third option would be public “insurance” companies (i.e. the government) but that would defeat the purpose of a “free-market” system.

Your fourth quote seems to suggest that universal healthcare is simply everyone buying into Medicare. That’s a false assumption. You also state that the “payer is not the only difference between England and the USA”. That is a correct assumption. The system in the US is so convoluted and expensive due to insurance companies being the middle man in everything. In true universal healthcare systems, the people don’t need to deal with insurance or “healthcare plans” for basic healthcare needs (and “basic healthcare needs” depends on the country but usually covers everything expect cosmetic surgery, dental, glasses, some physio, etc.). As a resident you get a healthcare card which you present when receiving “basic healthcare”. No plans that you have to update. No need to be screened for “pre-existing conditions”. Simply, resident = healthcare card = free basic healthcare. So the universal healthcare I, and others, are advocating for is more than simply forcing people to buy into Medicare. You need to get rid of the whole concept of applying for and acquiring insurance to receive basic healthcare. Your residency should entitle (yes, that dirty word for our libertarian friends) you to free basic healthcare. Just as you residency entitles you to other basic human rights.

 

[beej67]

I fail to see how any of that supports a “free-market” system or provides a rational argument against a universal healthcare system.

Start by identifying the problem you're trying to solve. That's what we engineers do. First identify the problem.

Is the problem "lack of coverage?" Or is the problem "cost?"

If we identify "cost" as the problem, then examining cases of unnecessary cost in our system, as compared to all the other systems in the world, should be of paramount importance. If, upon examination, it becomes clear that the "publicness" or "privateness" of the cost sharing pool would not have affected the cost, then we rational engineers must turn our attentions to aspects other than "publicness/privateness" to find our solution.

You also state that the “payer is not the only difference between England and the USA”. That is a correct assumption. The system in the US is so convoluted and expensive due to insurance companies being the middle man in everything.

You appear to be trying to claim that the "privateness" of our cost sharing pool is the source of our higher cost. This argument doesn't hold water, because our cost per capita for Medicare recipients is approximately as high as our cost per capita for insurance recipients. This is because when a medicare recipient strains their knee playing soccer, they go through the same highly expensive song and dance that a private insurance recipient goes through. The problem is not how the cost is shared. The problem is the song and dance itself. And we have all the evidence in the world that putting everyone on Medicare instead of private insurance would still mean the same song and dance, which means the same cost.

We already have vast, extensive test cases for "single payer" (Medicare) and for "single provider" (the VA) here in the US. We already know how they work here, within the rest of the system. Single payer does not make things cheaper. Single provider does, but at the cost of letting people die while they wait for treatment. Those facts are plain as day. Spending all day arguing about public vs private cost sharing is like trying to fix a broken car by repainting it over and over, and swapping out the hubcaps.


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[IRstuff]

" because our cost per capita for Medicare recipients is approximately as high as our cost per capita for insurance recipients."

That's not a valid comparison, since Medicare does not provide the health care itself; that care is still provided by the same people who provide the care to other insurance recipients. It's not a true single-payer system, since Medicare doesn't have sufficient clout to force costs down. In fact, there are lots of doctors that refuse Medicare and Medicaid because the reimbursements are too low. In a true single-payer system, Medicare would be the only game in town; to refuse their patients would then be tantamount to choosing another profession.

A more valid comparison would be the VA system, which administers both cost and providers:

http://www.rand.org/blog/2012/08/socialized-or-not-we-can-learn-from-the-va.html

Nevertheless, one should be cognizant of the fact that the VA's patients have an inherently different mix ailments compared to the general population.

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[beej67]

The VA system is not "single-payer," it is "single-payer-single-provider." It's true bread-line style communism. I'm presuming not even the Blues think switching the country over to the VA is a smart idea. I personally don't see why we don't simply do away with it entirely and give vets a voucher.


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[IRstuff]

" why we don't simply do away with it entirely and give vets a voucher."

Because their costs would pretty much double.

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[beej67]

I don't see how - their efficiency is reported to be about half that of the private system.

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[beej67]

Further, this right here:

That's not a valid comparison, since Medicare does not provide the health care itself; that care is still provided by the same people who provide the care to other insurance recipients.

...is pretty much my point. It is the only valid comparison, since it is the only attempt on the planet to produce a single payer version of our system. Single payer in the USA is simply "everybody gets Medicare," in which case all our taxes go up to cover it, and the cost per capita doesn't really change. That's because the cost problem is not the payer, the cost problem is the system. If we could somehow wipe our system out and drop in Denmark's system in its place, with Denmark's doctors, Denmark's nurses, Denmark's lawyers, Denmark's tort law, Denmark's version of their AMA, and Denmark's citizens (which are healthier than ours) then single payer would work great with it. The reason why isn't the payer, it's because my primary care doctor would be sending me home with a bottle of advil and an ace bandage instead of sending me off to see a specialist before getting a needless MRI, seeing the specialist again, and going home with a prescription for something that's not fundamentally better than Advil and a brace that's not fundamentally better than an ace bandage.

Do you see?

The payer is not the problem. The system is a feedback loop of cost pressures.

In order to fix the thing, we need a way to prevent doctors from prescribing needless medicine. In Denmark, the doctors do that on their own because they're Danish and that's what the Danes do. In the USA, our doctors are like McDonalds front line clerks, asking "Would you like to upsize for an MRI and a large coke?" ..and they justify that by a blend of extreme hippocratic oath-taking and liability avoidance. Look no further than surgery rates. Can't remember whether this was linked above or not, but check out the abstract:

http://www.ncbi.nlm.nih.gov/pubmed/8073310

For back surgeries, the US had at least 40% higher rate per capita than anywhere else in the world. That's a cost. It gets shared. If the same stands for all other types of surgeries, then our per capita health cost rate is pretty easy to explain, and it has very little to do with whether the sharing pool is funded with taxes or earnings.

These are the sorts of things that engineers, focused on the actual problem, should be looking at when they struggle with fixing the health care problem here.


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[IRstuff]

"It is the only valid comparison"

No, it's not. 44 million people were covered by Medicare in 2010, which is only 17.3% of the total number of people covered by any sort of insurance. That's not enough of a market share to drive prices as low as they could go. Medicare costs are still climbing at about the same rate as the general insurance population. But, because of the low market share, this does not prove that a single-payer system in the US wouldn't work. That's not to say that there aren't other issues, but to continually bash doctors isn't exactly the answer. They respond to market forces; if a patient demands a certain drug or treatment and is refused, the doctor is likely to be complained against, which, while less than a malpractice suit, is still a nuisance, time consuming, and affects their standing relative to insurance payers.

A more valid comparison might be Walmart. They do have sufficient market share against their suppliers and are able to demand pretty much any sort of price control they want. The suppliers either find a way to make cost cuts, or basically go out of business. So we know that in the full-blown free-market, a single payer can and does command whatever price it wants.

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[IRstuff]

On further reflection, it is a valid comparison, because it does prove that a single payer system could work. Medicare covers 44 million people, yet there are doctors refusing Medicare and Medicaid patients because of the low reimbursement rates. This says two things, in areas where doctors have plenty of other payers, they can and will bail, but in areas where Medicare patients are in the majority, the doctors and hospitals do knuckle under. This, therefore, does confirm that a single payer system can and will work in the US.

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[rconnor]

You appear to be trying to claim that the "privateness" of our cost sharing pool is the source of our higher cost. This argument doesn't hold water, because our cost per capita for Medicare recipients is approximately as high as our cost per capita for insurance recipients

No. It’s the for-profit nature of insurance companies and hospitals in the US is the reason your costs are so high. Sending you off for expensive treatments and tests is a great way to increase profits and so these for-profit hospitals are highly motivated to do so. Insurance companies, for those that can afford insurance, should step in and put a stop to this. However, it’s much easier and cost efficient to either (a) deny coverage (which was the modus operandi prior to the ACA) or (b) raise rates (which is now the modus operandi after the ACA). Thus, both for-profit insurance companies and for-profit hospitals privatize the gains and pass the costs onto the public. A “free-market” system does nothing to alleviate this problem.

In a universal healthcare system, where there are private or public non-profit hospital and a single public payer, this same profit-driven model inherently does not exist. Rather than profits, the right care for the right cost is paramount. This is why, in the real world, the cost of universal healthcare is much lower and the people are healthier.

Beyond that, the very existence of insurance companies and healthcare plans for basic healthcare is an unnecessary expense that does not exist in universal healthcare systems. As I just explained:

Your fourth quote seems to suggest that universal healthcare is simply everyone buying into Medicare. That’s a false assumption…The system in the US is so convoluted and expensive due to insurance companies being the middle man in everything. In true universal healthcare systems, the people don’t need to deal with insurance or “healthcare plans” for basic healthcare needs…As a resident you get a healthcare card which you present when receiving “basic healthcare”. No plans that you have to update. No need to be screened for “pre-existing conditions”. Simply, resident = healthcare card = free basic healthcare. So the universal healthcare I, and others, are advocating for is more than simply forcing people to buy into Medicare. You need to get rid of the whole concept of applying for and acquiring insurance to receive basic healthcare.

My response to you at 4 Dec 14 16:05 listed numerous reasons why insurance companies are culpable in US healthcare costs being the highest in the developed world. You (in your 23 Sep 14 9:32 post) state that your “perfect system” would be to have emergency services “handled on a single government payer model” but seem to imply that insurance would handle non-emergency care (correct me if I’m wrong). Would routine checkups be on insurance? What about treatment for chronic, non-emergency ailments? What about cancer treatments? You still have insurance companies involved in a very large portion of healthcare system and so the issues remain, specifically with the added costs of making preventative care inaccessible to many such that small things become large healthcare problems. The inaccessibility (due to cost/lack of coverage) of preventative care is a major reason why the US system is the worst in the developed world.

This leads into your asinine question - is the problem “lack of coverage” OR “costs”? As an engineer, if a design is BOTH unsafe and expensive, I don’t choose to fix one and ignore the other. There is no OR, BOTH are serious problems with the US healthcare system, as supported by the research. And, as supported by the research, BOTH appear to be much less of a problem in universal healthcare. No evidence has been brought forth to support a “free-market” system solving EITHER - most certainly not the former and, if you keep insurance companies as a middleman in everything, likely not the latter. So as an engineer, if I have one alternative that solves both problems and a second that MIGHT solve one problem but likely makes the other problem worse, I’d go with the first alternative. But that’s just me.

Regarding “single payer”/”single provider”, again you miss the point. Almost all other universal healthcare systems are not “single provider”, they allow private non-profit hospitals which bill the government (as long as they meet certain standards) and people are free to choose which doctor and which hospital they visit (which is actually untrue in an insurance based system). And as previously discussed (at least twice now), universal healthcare is NOT simply everyone buying into Medicare insurance as true universal healthcare is NOT an insurance based system when it comes to basic healthcare needs.

 

[rconnor]

The payer is not the problem. The system is a feedback loop of cost pressures.

I agree (mostly). The system is feedback loop of cost pressures due to private, for-profit insurance companies and private, for-profit hospitals trying to squeeze as much out of the consumer as possible. Universal healthcare inherently eliminates that, as per all your examples of how universal healthcare in other countries is so much better...while at the same time fighting tooth and nail against the US adopting universal healthcare(!?!?!??!?!?!?!?!?!?!?). A “free-market” system does not. It puts more power into the hands of insurance companies and private, for-profit hospitals and asks the consumer to fend for themselves. This makes the “feedback loop of cost pressures” worse.

In the USA, our doctors are like McDonalds front line clerks, asking "Would you like to upsize for an MRI and a large coke?" ..and they justify that by a blend of extreme hippocratic oath-taking and liability avoidance

Agreed! All of which is solved by going to a universal healthcare system (note: most universal healthcare systems came with laws that limit the liability of doctors). None of which is solved by a “free-market” system.

Beej67, 95% of your posts are explaining the issues with the US system, that exist only because there isn’t universal healthcare, and why these issues don’t exist in countries with universal healthcare. The remaining 5% is concluding that the US shouldn’t adopt universal healthcare and should adopt a “free-market” system that doesn’t address any of the issues with the current US system (and likely makes them worse).

 

[beej67]

No. It’s the for-profit nature of insurance companies and hospitals in the US is the reason your costs are so high.

This is a talking point that the single-payer crowd loves to repeat, but the numbers simply don't back this up. Lets look at this graph again, which summarizes the problem:

We pay double what we should be paying per capita. If the profits were the problem, then 50% of the gross revenue in healthcare in this country would go towards profit. It does not. Most health insurance companies report profit margins at or below 5%:

http://abcnews.go.com/Business/health-insurance-profits-worth-outrage/story?id=9036632

If you switched everyone in our system to non-profit, you get a 5% savings, not a 50% savings.

It's not the profit that's the problem. It's the revenue that's the problem. The problem is over-use of the system. The problem, again, is this:

..it's because my (Denmark) primary care doctor would be sending me home with a bottle of advil and an ace bandage instead of sending me off to see a specialist before getting a needless MRI, seeing the specialist again, and going home with a prescription for something that's not fundamentally better than Advil and a brace that's not fundamentally better than an ace bandage.

Now, on to the meat of the issue..

The system is feedback loop of cost pressures due to private, for-profit insurance companies and private, for-profit hospitals trying to squeeze as much out of the consumer as possible. Universal healthcare inherently eliminates that, as per all your examples of how universal healthcare in other countries is so much better...

Please explain to me how switching from multi-payer to single-payer eliminates over-use of the system. "Single payer" is just "everyone gets Medicare." That's all it is. Explain to me how "everyone gets Medicare" eliminates over-use of the system. People on Medicare currently use the heck out of the system, at the recommendation of doctors, who are steered by their "at-all-costs" hippocratic oath and their desire to avoid lawsuit. How does "everyone gets Medicare" fix that, and why is that fix unique to the "everyone gets Medicare" solution?

In what seems like a thousand posts, you have failed to make that connection clear.

Please consider, when crafting your response, how Medicare in the United States is beholden to medical lobbyists trying to shoehorn every proprietary medicine into blanket coverage, to make their company more money. Also consider how modern medicare doctors actually over-prescribe procedures and tests on the presumption that they'll get paid enough on some of them to make their ends meet.

Changing the payer doesn't fix this. Hell, insurance companies have every incentive in the world to fight this, and do their very best to do so, and can barely keep it under control. And every attempt they make to keep this trend under control gets attacked from the AMA, because the insurance company is "interfering with the doctor's judgment." How would Medicare-for-everyone fix this, without interfering even more with the doctor's judgment?

That's the question. That's the thing that needs to get fixed. In the old days when we were paying cash, we customers opted out of the pointless MRI. Now that we're sharing costs, we customers are opting in for extra pointless MRIs. Fix that. Show me how "everyone gets Medicare" fixes that.

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[JohnRBaker]

If you REALLY wanted to solve this problem in the US, along with a bunch of others, just remove, or at least drastically reduce, the infusion of corporate cash going into the reelection coffers of our elected officials and their political parties. And if you've been following the national news recently, you'll know that it's only going to be getting worse. The soon to be signed end-of-the-year spending bill coming out of Congress will open the floodgates even further for the billionaires and corporations being able to 'buy' virtually all of our politicians and it was designed specifically to assure that anyone not toeing the lines of the two major parties, that they will be completely cut-out from getting virtually any money whatsoever.

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[moltenmetal]

If you believe that only 5% of your healthcare system's cost is in the form of profit, there's no point in talking about this further.

One important reason that single payor systems are cheaper is that the entire profit motive is eliminated from the system. That's a hell of a lot more than 5% of the cost!

The other important reason is that single payor is more efficient, i.e. it costs less in administration cost to deliver services of the same value in terms of outcome. As I've noted before, I have friends who own a mobile medical imaging business- and 30% of their employees are associated merely with the process of BILLING for their services. That entire infrastructure is GONE from our single payor system.

 

[KENAT]

Crazy talk, how can a government run system be more efficient than the 'free market' oh the bureaucracy.

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[IRstuff]

"We pay double what we should be paying per capita. If the profits were the problem, then 50% of the gross revenue in healthcare in this country would go towards profit. It does not. Most health insurance companies report profit margins at or below 5%:"

Profit margins are mythical, just like the movies that gross $1B with a cost of $250M, and claim no profit exists. Moreover, profit is made through the additional and unnecessary procedures that you pointed out. For-profit company executives are not graded on just profit margin, but increased absolute profit, which requires increased absolute revenue. This is what their bonuses are based upon.

The graph shows that our health system's performance is quite pathetic, so I'm not sure why anyone would even imagine that the current system can be "fixed." It looks like we're actually spending more than 3x what we should be spending to get the results that we have. Given that the government insurance plans cover less than 1/5th of the US population, with the remainder being either covered with private insurance or none at all, what possible reason is there for maintaining that the current system is even plausible?

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[cranky108]

Has anyone thought that maybe the problem is a lack of doctors and hospitals. And that allowing more doctors from other countries might be the answer?

After all who ever thought you could cure anything by sticking needles in your back?

The failure is the education system more than anything. Those costs keep going up, and I don't hear any commonalities with that.