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?

 

[IRstuff]

Engineer's in general, have not been successful in running companies. And note that the current crop of airline companies have demanded ever smaller pitch on airline seats, to the point where fights now break out if what little extra room we are supposedly entitled to get infringed upon. So, yes, you get to fly trans-Atlantic, but do so packed as a sardine in a tin, or composite, can. The future plane won't even allow you to see out a real window.

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[glass99]

IRStuff: In spite of high oil prices and the obvious difficulty of getting a 200ton chunk of aluminum to fly, air travel is cheaper and more accessible to the mass of humanity than it has ever been. Bitch about the food or whatever, but I still chalk it up as +1 for engineering. Over the same period, the cost of a simple trip to the doctor for a runny nose has tripled. Two of the largest and most revolutionary corporations of our age, Google and Apple are run by engineers. A little bit of efficiency injected into the medical world could do no harm.

 

[Tunalover]

I beg to differ with you IRStuff. You pushed a button with your opening statement.

Some of the best run companies in the world are run by exceptional engineers. It's the MBAs that have hurt their companies by focusing only on short-term profits, failing to gain an understanding of the departments they control, cutting training, shortening schedules, cutting budgets, and making asinine decisions affecting engineering and manufacturing. The success of a company depends on the sale of its products. It takes good engineers and production people to make these products of sufficient quality, function, and appearance to sell. Thus it takes good engineering and production for a company to be successful. Perhaps the biggest shortcoming of many engineers-turned-executives is their shortage of emotional intelligence and people skills. Exceptional engineers-turned-CEOs have these skills but also appreciate the profound effect engineering and manufacturing have on the company's success. Of course I'm probably preaching to the choir in this forum !



Tunalover

 

[glass99]

Tuna: Yes, you are preaching to the choir, but that's ok. Insofar as emotional intelligence goes, its not like doctors or MBA's are really that amazing. They just lack the intellectual rigor of engineers. I don't think Elon Musk has ever felt an emotion in his life other than being excited about space ships, yet he manages to struggle on. My only hope is that he has a go at health care.

 

[hokie66]

Sorry to pile on, IRstuff, but I agree with glass99 and tunalover. Approximately a third of S&P 500 companies have engineers as CEO.

 

[IRstuff]

"Approximately a third of S&P 500 companies have engineers as CEO"

I would argue that they WERE engineers, but mea culpa; I didn't fact check.

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[glass99]

I would argue that there are two parts to medicine: the exciting progressive part that invents things like penicillin and genetic therapy and looks like engineering, and then the part which doctors do which looks like haggling about camels at a Moroccan bazaar.

 

[hokie66]

In the context of whether the CEO's WERE engineers, they had engineering educations. Therefore, they had the grounding necessary to succeed in the corporate world.

My memory was faulty, and this was from 2006. The number with undergraduate engineering degrees was 23%, still greater than any other category.

http://www.arecentstudy.com/studies/S&P 500 CEOs.pdf

 

[moltenmetal]

Many things about healthcare drive me crazy, but the one I understand least is why doctors are so stubborn about the division of labour. Their lives, and the cost of the overall healthcare service, would be much better if they allowed cheaper staff to do more of the routine work, saving them for the things really needing a physician. That works at least in theory in hospitals (though nurses complain about the doctors being tyrants there too), but in family practices it's all on the physician usually and we pay the whole shot as taxpayers for that. Probably 80% of what a family GP does could be done by people with far less training at far less cost, and health outcomes wouldn't suffer one iota. There'd be no shortage of people wanting those jobs, which even though they pay less than what a physician earns, they still offer people an opportunity to earn a very good living. I've met the odd enlightened GP here who sets up a multidisciplinary practice and loves it, again because they get to focus on what they're trained for.

The other professions, including ours, have figured this out, at least better than the docs have.

...oh, and the medical error-related deaths too- if we killed even 1/10th as many people with our mistakes as doctors do, there'd be a Royal Commission of Inquiry into the profession of engineering in a heartbeat.

 

[swall]

Can any Canadians shed light on the negotiated prescription drug prices? Why would the drug companies even participate unless they are still making a profit? It is also my understanding that Canada's program does not cover ALL drugs and the companies are still free to charge market prices on those. Yes, no?

 

[JohnRBaker]

My wife was a consultant for years in the dental segment of medical care. She specialized in the 'front office' part of the business and that was where the problem was, it was a 'business'. Now I realize that a dental office is a much less complicated environment than a GP's office, but it's still a 'business'. As my wife used to say (she's been retired for about 7 years now) these dentists, and I suspect the same could be said for GP's, spend years in medical school yet they learn very little about what it takes to run a business. They get little or no training in accounting, marketing, employee relations, etc, yet most of them end up trying to run 'million dollar' businesses. For something like 25 years my wife made a very good living helping these 'amateur entrepreneurs' get their offices running smoothly, usually after they had screwed things up to where they realized that they needed the help of an outside 'professional'.

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[CELinOttawa]

Negotiated drug prices occur because the Canadian Confederated (long story, but most people just call it "Federal") government and most of the provincial governments are not shy to threaten legislation.

It is also not at all unique to Canada. There just seems to be no will for it to occur in the US.

It goes like this:

Gov: We'd like to negotiate a bulk-buy of your medication.
Producer: We don't sell in bulk or negotiate market prices.
Gov: Sure you do. Besides, you want to help us out.
Producer: It is our policy to no sell in bulk or negotiate market prices.
Gov: We've been thinking about passing legislation making it legal to copy your drugs without payment, and may also work to ensure that you cannot obtain any of our research grants, while denying any future approvals in order to deny you what is effectively a large fifty-first state of market share.
Producer: We'll take cost plus ten percent.
Gov: Make it five percent; Sign here, here, and here. Thanks. Knew you could help us make this work for everyone.

Many of the drug companies cave under very little pressure, and genuinely don't know that the Gov's both could not and would not follow through on any of their threats. Frankly I think the current government might actually follow through on some of those threats if they needed to, so it is likely wise that the drug manufacturers blink.

Note that it could be far more effective than it already is, and in fact I paid far less for drugs while living in New Zealand than I do here. It just isn't as bad as the states.

Business is business. As long as it is more production for more profit, the drug companies will negotiate and will set far lower prices than people in the States pay.

 

[ornerynorsk]

The downside to the coercion scenario is that, once companies have that happen to them a few times, especially as everything becomes more NWO and globalized, there is no longer any incentive to offset the cost and risk in new drug development. Money makes the world go 'round, and as more things come under the thumb of government and regulation, we slowly grow toward a soviet-style utopia with less and less innovation and enterprise. The government doesn't give a damn if we cure diabetes or find a way to beat cancer.

It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.

 

[moltenmetal]

Pharma companies spend more money on marketing than they do on research and development, trials and all, so there's no shortage of money for R&D in their coffers. What they don't do is try to cure disease- they like to make drugs for chronic diseases so you have to keep buying the drugs. There's no money in new antibiotics, so they don't develop any. And no money in a cure for malaria either, despite how many people it still kills yearly.

I suggest that we all stop thinking about these products as if the laws of the free market work on them: they're NOT commodities when a person's life hangs in the balance!

The reason the pharma companies cave is that they have to. They cave big time when the patents expire and the generics come on the market. The patents give them a monopoly on supply for 20 years- the government is merely being a monopoly buyer, leaning back a bit.

The provincial plan doesn't cover ordinary prescription meds- yet. Most people with decent company bennies get their prescription meds covered that way, just like in the US. The provincial plans vary in what they cover and what they don't, and for whom and under which circumstances, and those assessments for very costly but potentially life-extending drugs are based on medical evidence- there are still stories in the media about people mortgaging the house to pay for some of these high-cost drugs because they're not on the provincial formulary yet. But even for the drugs that aren't covered by the provincial plan for the average Joe, the provincial health system is a major purchaser simply because it buys all the meds used in all the hospitals. They are hence a huge purchaser and they use that power to lean back. The price they set is the price the local pharmacies buy at too, making the price for all of us lower.

 

[IRstuff]

Drug companies in the US make obscene profits; they just don't report net profits that large. And that's because their drug reps are allocated sufficient money to pop into a doctor's office every month and buy everyone a REALLY NICE lunch.

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[CELinOttawa]

Interesting:

http://pipeline.corante.com/archives/2010/11/04/where_drugs_come_from_the_numbers.php

 

[davefitz]

Well, there are many critiques of the drugs companies that can voiced here, but it doesn't seem to be related to engineering per se. In any case, it has been elsewhere reported that the drug companies have on staff 4 lobbyists for each and every member of congress, so they are able to exercise their "right of free speech" far more than does any competing interest. On the same subject, the US evening news on the 3 major televised networks seems to be primarily a platform for advertizing the latest fashion drug. The policy of allowing the drug companies to "own the news coverage" implies that they also have editorial control of what is not discussed on the news. So, between owning the news program editors and owning the congress, one can suggest they can fashion the laws to their benefit and prevent any effective discussion of their misdeeds . I t goes without saying that each and every cash settlement negotiated with their court plaintiffs comes with a "non-disclosure agreement" so the same evidence cannot be used in further court cases on be published in the newspapers. Like some other aspects of our modern life, it displays some systemic defects of our means of governing ourselves.

"Whom the gods would destroy, they first make mad "

 

[beej67]

Lets pretend that someone passed a law stating that car insurance should be changed to a "car plan," covering oil changes. For our own safety. But you can only get oil changes "in network," and you can't do them yourself, because that's dangerous, and the government is worried about your safety. So the cost of car insurance (now Car Plans) goes up. Furthermore, since nobody's actually paying for the oil change, nobody shops around, so the mechanics start charging double. Some even go so far as to charge different people different sums of money for the same oil change, since nobody's paying attention anyway.

Then lets pretend that the Car Plans also cover gas, with a $5 co-pay at the gas station, regardless of how fat your car is. Well then nobody'd buy fuel efficient (skinny) cars, and nobody'd conserve their own gas use, and the cost of Car Plans goes up even more. Oh and since nobody's shopping for cheap gas, they can charge more per gallon as well.

Oh but each station only sells one kind of gas. If you need premium gas, you need a referral, and you can't get buy it unless you go to the Regular gas station, talk to the attendant, and he refers you to the premium gas station.

Also, wait a sec, he needs to be qualified to give the recommendation, with at least an 8 year college degree and another four years worth of residency at Quik Trip. So, you know, higher wages for him, and the price of the Car Plan continues to climb.

Then the Car Wash Lobby gets in and convinces folks to change the coverage rules, so Car Plans have to provide a car wash once a month. Everyone has shinier cars, and the cost goes up again.

And because the costs keep skyrocketing, everyone clamors about how the Free Market simply isn't working! Oh golly, shopping for Car Plans just isn't keeping our costs low. We need Single Payer car plans. Universal MediCar! ObamaCar!

...

So yeah. That's why health care is expensive here. 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.



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[ornerynorsk]

beej67, oh, the car plan IS coming at some point in time. We have the makings of it already in annual inspections in certain states. And why not, dammit, it makes everyone safer and it's good for the environment, right?!? Let's not forget the home situation, either, with checking for mold, radon and allergens in your house, if you're doing an adequate job raising your kids, etc.

The problem with the vision of a government that's "gone nanny", is that they don't know when to stop. This will continue to regress until the liberties and freedoms acknowledged by the constitution and bill of rights are simply a fond and faded memory, a footnote in the history books. Put some serious thought into it, 1984 is not that far off. (waits for the slight pause as the staunch traditionalists become alarmed and emit a proper blubbering of protest)

It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.

 

[rconnor]

It’s not that the healthcare system is broken, the US still has the finest in the world

Ummm...is it?

beej67, applying this same logic to other countries such as Sweden or the UK, it would seem that they too would suffer from a “lack of an individual’s motivation to keep their own costs down and the systems motivation to do everything to drive costs up”. Being publically funded (socialized), they should be even worse than the US. However, this is opposite from reality. The (2011) health expenditure cost per capita of both Sweden ($3,925) and the UK ($3,405) is less than half that of the US ($8,508). Furthermore, the socialized systems of the UK and Sweden should, according to this logic, be bogged down to bureaucratic inefficiencies. However, they ranked first and second in “efficiency”, while the US was dead last amongst other Western nations.

The free market is not the panacea of the health care system, quite the opposite. The free market is great at commodifying and profiting off things. Sometimes, it has the co-benefit of improving society but this is not it’s goal. If there is a conflict between profits and what’s in the best interest of society, profits win (actually, they LEGALLY must win due to Dodge v. Ford). This is fundamentally problematic for something such as healthcare which, as moltenmetal stated, is closer to a basic human right than a commodity.

The failure to recognize this by free market enthusiasts largely stems from a bizarre and contradictory notion that when good things happen, it was the free market working the way it should and when bad things happen, it was regulations preventing the free market from operating efficiently.
1) The free market is the most flexible, adaptable, responsive system ever contrived. It is the solution to all social and economic issues, under every possible situation. (i.e. free market during boom periods)
2) Regulations, regardless of their extent or rigidity, completely undermine the free market and destroy its ability to operate effectively. The free market is completely inept at being able to adjust to any and all regulations imposed upon it. (i.e. free market during bust periods)

1) Without the competition that the free market offers, companies will greedily raise prices and lazily let quality slide. Consumers, being mindless drones, won’t respond. A 1984-esque society will emerge. (i.e. socialized healthcare…despite all real world evidence)
2) Without the regulations and corporate laws, companies will act in the best interest of the consumer and society at large. Consumers, being citizens of change, will effectively boycott, in mass, those companies that don’t. An egalitarian society will prosper. (i.e. free market healthcare…despite all real world evidence)

1) The free market works efficiently because consumers respond strongly to price points and thus puts pressure on companies to improve efficiency and drive down costs. (i.e. why Walmart does so well)
2) The free market works ethically because consumers don’t respond strongly to price points and thus will encourage companies to act ethically and in the best interest of society even if that means increasing prices to do so. (i.e. why Walmart does so poorly…wait…)

Given this contradictory stance, it’s no wonder that some will continue to believe that the US health care system needs more free market solutions, not less, despite all the evidence supporting the opposite.

I’m getting déjà vu from this discussion…one side using belief that the free market will solve all life’s problems (and, conversely, regulations cause all of life’s problems) and the other side using real world evidence to counter this stance…sounds oddly familiar…