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]

"patients (a.k.a. customers) need to push back on the cost at the time that treatment decisions are being made with the doctor."

That works when you are buying a car, where you have no compelling reason to buy now, or buy here. When you are sick or dying, it's a different thing altogether.

When my son is in the ICU for pneumonia, which he was, was I really going to pull him out to go to another, cheaper, hospital, or call a bunch of hospitals and get a lowest bid? Am I really going to try an negotiate a lower price right there for the MRI that he got? Seriously? Even the free-marketers will admit that getting treatment from a doctor is not the same as buying a car.

TTFN
faq731-376

Need help writing a question or understanding a reply? forum1529

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

 

[IRstuff]

Bear in mind that most insurance plans go out of their way to not pay for preventative care, so the end result is that you are more likely to get sick, and when you do get sick, it's worse, both of which are good for the profit picture. Neither insurance companies or hospitals are necessarily interested in driving themselves out of business by eliminating sickness. This is why vaccinations have to be semi-mandatory. My company is self-insured, and they only recognized last year that free flu shots would reduce the number of sick days and increase productivity. What a concept!

TTFN
faq731-376

Need help writing a question or understanding a reply? forum1529

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

 

[beej67]

beej67 the issue is multi factorial, at least some of the single payer systems around the world do one way or another reduce the litigious aspects that impact US system so much.

Oh I agree. The litigious nature of the US system is one of the biggest difference between our system and other systems, which leads to over medication, and is a huge burden. But A) simply switching to Medicare-For-All doesn't fix that, and B) there's no reason we can't fix that in a multi-payer system.

The how-we-share-costs issue and the litigation-breeds-over-medication issue are separate issues. Either can be changed without changing the other. To date, none of the Blue "single payer" proposals has touched tort. At least as far as I've seen. And tort is one of about ten things we seriously need to overhaul, that pushes us into over-proscribing procedures.

True but, no other legal system in the world incentivizes back surgery like ours does. I am not saying that these surgeries are necessary. They clearly aren't. What I am trying to say is that the legal system rewards and incentivizes unnecessary back procedures by awarding significantly larger verdicts to plaintiffs who undergo them. My point is that if you want to talk about the US medical system as a whole you need to choose a procedure that is not influenced significantly by other factors.

What, like pregnancy? Our C section rate in the US 30%, Belgium's is 15%. The reason why is we put everyone on an epidural, which slows contractions, then put them on pitocin, which causes contractions to be more violent, and then when the baby freaks out we cut it out with a knife. Birth by C section costs three times as much as vaginal delivery.

There's that X3 multiplier showing up again, and not due to a profit factor for the insurance company. They don't want to pay for C sections either.



Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[beej67]

I want to go back to this for a second:

The reported profits mythical. How else do companies like GE get away with paying little or no taxes? There are gigantic tax law loopholes for companies and 1-percenters to shield hide the true profits.

Lets talk GE. How does GE do it? I know quite a bit about how GE does it, because my brother in law is the chief alternative energy reporter for Bloomburg. GE does it by buying themselves tax breaks through carefully placed campaign donations, under the guise of things that Blue voters would support, to sneak them under the radar. Here's an example.

A few years ago, GE lobbied some language into one of the energy policy laws that was supposed to support 'green energy.' The language stated that any alternative energy project that got started that year, could be fully depreciated in that year, instead of along a normal depreciation schedule. Basically, instead of counting as an asset on their books, it was counted as an expense. So that year, if GE made 100 million in profits, they could start work on 100 million dollars worth of solar farms or wind farms or algae fuel laboratories or whatever, and fully depreciate them right then, and have no taxable income.

Neat trick, huh? How'd they get that trick off? They bought Washington.

They bought Washington.

And there, sirs, is one of the biggest difference between the USA and Denmark. You can't just knock off down to Copenhagen and buy yourself a tax break. But lobbyists don't just buy tax breaks. They also buy everything else, such as drug coverage and procedure coverage under Medicare. How on earth could you seriously support going to "Everyone Gets Medicare" as a solution, when the very things Medicare covers are up for sale, in the very same way that evil old GE's tax breaks are?

You cannot even engage the idea of putting all paying under one umbrella until you fix the umbrella. If our government worked as intended, then it might be conceivable. But it does not. It is purely a complex web of graft. Fix that first. I'm open to ideas how.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[beej67]

Bear in mind that most insurance plans go out of their way to not pay for preventative care, so the end result is that you are more likely to get sick, and when you do get sick, it's worse, both of which are good for the profit picture.

No.

If Insurance was raking a percentage of claims paid, then you'd be correct, but that's not at all what insurance is. Insurance gets paid up front, in premiums, and then strives to maximize profit by paying as few claims as possible. Every claim paid is lost profit. They have more incentive than anyone to not pay claims...

...which means they have more incentive than anyone to insure healthy people. They have every incentive in the world to pay for preventative care that shows an ROI. In many cases, they are flat out prevented from doing so by law. Insurance companies would love to structure coverage by BMI or percent body fat, for instance, but it's illegal. Who made it illegal? Lobbyists.


Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[beej67]

For a private system to be made to work, patients (a.k.a. customers) need to push back on the cost at the time that treatment decisions are being made with the doctor. If this can't be built into the structure, costs will continue to rise. In a public system, the government has the power to impose whatever cost structure the tax payers are willing to pay for without worrying about making a profit or getting sued.

I agree with all this, and this is one of the reasons I would totally support single payer emergency care. If you get in a car wreck, you do not have time to shop for your medical provider. Car wrecks should be like your house burning down, or like getting robbed. Emergency hospital care makes complete sense to cover with taxes. No marketplace can reasonably exist for it.

Colonoscopies, however, should be paid for out of pocket. Here's an interesting article:

http://www.nytimes.com/2013/06/02/h...ld-in-health-expenditures.html?pagewanted=all

There's lots of "evil profit seekers!" in that article, and a lot of it's legit, but there are two important things to take away from it:

1) In other countries with single payer systems, the administrators of those single payer systems can decide that colonoscopies really aren't needed if there are other tests that are cheaper. That wouldn't work here, because the AMA would lobby congress to have Medicare pay for the expensive treatment.

2) In other countries with an actual free market (which is NOT what we have here) where the patient is paying with cash, the patient is free to seek the most affordable screening option, which is typically not a colonoscopy or is a colonoscopy in a doctor's office instead of a surgical center. That doesn't work here, because we're going to pass the costs on to our shared pool anyway, so the doctors brew up a more expensive version of the same thing to sell to the shared pool.

We do not have a free market here. We do not have universal healthcare here. We have the worst, most insidious blend possible of the two.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[jguer005]

jguer005,

1) Right, that’s why all universal healthcare systems have no good doctors and the quality of care is poor…and then there’s reality. Quality of Care Rank: US – 5th out of 11, UK – 1st. (source)
2) And? Every nation that has universal healthcare went from non-universal to universal. Most of these transitions included limitations on liability. Difficult and impossible are two different things.
3) Right, that’s why all universal healthcare systems have poor quality of care…and then there’s reality (see above). (bonus points for using “apathetic” to describe universal healthcare while arguing for a system that lets millions go uninsured or underinsured for basic healthcare needs and ~45,000 die due to a lack of coverage.)
4) And? Are you saying it could be worse (all for-profit hospitals)? Ok. But that’s not an argument against universal healthcare. Furthermore, a true “free-market” system would have all private, for-profit hospitals. So it WOULD BE worse according to this argument.
5) Right,…never mind….just see 1 and 3 again. (and more bonus points!)
6) Right, that’s why all universal healthcare systems cost so much more than the US system…and then there’s reality. With a good portion of the medical system being paid out-of-pocket by the people (through insurance premiums or directly), the healthcare system still costs Americans much, much more than any other western nation with universal healthcare. Percentage of GDP that goes to healthcare: US – 17.7%, Canada – 11.2%, UK – 9.4%. And the per capita expenditures are even worse for the US (US - $8,508, Canada - $4,522, UK - $3,405). (source)

Ya know, facts and such.

I think it is ironic that the "source" you cite is the Commonwealth Fund...whose president is an Obama appointee. Hmm, I guess that means they wouldn't be biased at all in this debate.

I won't disagree that "quality of care" is equal to or better in nations with universal healthcare; however, universal healthcare does not translate to access to healthcare. According to Britain's Dept. of Health, at any given time, there are 900,000 people waiting to be admitted to a NHS hospital and 50,000 canceled operations each year due to shortages. Woo-hoo! Please, put me on the next boat over so I can be on the wait list!

In Sweden, the wait list for heart surgery can be as long as 25 weeks! How many people will die during their wait time? Even the New England Journal of Medicine said in 2008 during the healthcare debate that "health insurance status was largely unrelated to quality of care."

Did you know that the CBO is estimiating that 31,000,000 US citizens will still not have health insurance by 2023. That is 10 years under the PPACA, and that is still 10% of the population uninsured.

You know, facts and such.

I won't argue with the % of GDP numbers, but I will argue that access to healthcare is not better under a universal system. It may be cheaper up front, but what are you really paying after all the taxes and fees levied by the gov't?

I shall not post anymore because I have to go to work to pay my increased taxes and health care costs.

 

[glass99]

The more the contribution of the public purse, the more political health care becomes. For example, I have noticed recently in Australia that there is a brewing conflict between old and young over items like healthcare in particular. Real estate has also become very expensive in Australia, which is owned to a significant extent by older people who bought in decades past. Young families argue that they can not afford the down payment on a house, but they have to pay high taxes to fund Medicare which primarily benefits their parents who are living in million dollar plus houses.

 

[KENAT]

"The more the contribution of the public purse, the more political health care becomes"

Color me unconvinced, while it was a frequent political hot potatoe back in Blighty I'm not sure it was any worse than here in the US.

In the single payer/single provider system I'm familiar with pretty much everyone got reasonable coverage for $X of GDP. There were issues such as long waiting lists at times for some procedures, some variability on quality of care geographically based on wealth distribution etc. however my experience with it - with admittedly limited need to take advantage of it wasn't bad.

In the US a few people get fantastic coverage, a lot of people get reasonable coverage, many more get mediocre coverage and a bunch get minimal - all for $2X GDP.

Posting guidelines faq731-376

http://eng-tips.com/market.cfm?

(probably not aimed specifically at you)
What is Engineering anyway: faq1088-1484​

 

[glass99]

Kenat: there has been a big uptick in the controversy of healthcare because of Obamacare, i.e. the government taking on a bigger role. Hippies in Vermont have different values than gun owners in Texas, so a political process is required to sort it out. The winner of the political process is the group with the most coherent voting block. Libertarians argue that forcing people who don't like each other to share a bed is not productive.

I understand in the UK right now, politicians of both wings are falling over themselves to say how much they love the NIH, but they are also scared witless of their budget deficit. There is a lively political discussion as a result.

 

[KENAT]

glass, I was here before Obama got elected I remember related topics coming up then.

NIH? you mean NHS?

NHS is far from perfect, overall economics, political system... is far from perfect there too. I wasn't proposing blindly copying the NHS model in the US. However, I am not swayed by arguments that the NHS is overall worse than the US system and would argue that as a minimum it gives much better overall value for money.

Posting guidelines faq731-376

http://eng-tips.com/market.cfm?

(probably not aimed specifically at you)
What is Engineering anyway: faq1088-1484​

 

[glass99]

Kenat: Its pretty clear that the British system is more efficient, which is a matter of national schadenfreude for all British citizens. But America is a big diverse country, and forcing people to share a bed when they don't want to is tough. If you are in a toxic relationship with your spouse, do you stay married just because divorce is expensive? The Texan gun owner would rather die than bunk up with a hippy, so paying double for health insurance is cheap by comparison.
-> Maybe the answer is to break America up into smaller countries. How expensive does healthcare need to get before this makes sense?

 

[rconnor]

Jguer005,

Sources
The Commonwealth Fund study is not out-of-line with other studies. Furthermore, as cost appears to be your biggest issues, those numbers were not calculated by The Commonwealth Fund (listed in the study).

Meanwhile, you didn’t even bother linking your sources. No matter, I went to the trouble of trying to find them. Seems like your numbers came from the same paragraph in “Universal Healthcare’s Dirty Little Secrets” by Michael Tanner and Michael Cannon, of the CATO Institute! My favourite source for credible, unbiased, non-ideological driven information!

Regardless, it matters little. Let’s return to the matter at hand.

Wait Times
As you popped into this conversation about 450 replies in, I’m guessing you didn’t read my post highlighting the facts of wait times:

% of Responses stating they could see a doctor the same/next day – Canada 41% (worst amongst OECD), US 43% (second worst), Sweden 59%, Germany 74% (best) (source)

Wait time for emergency case was 2 hours or more – Canada 48% (worst, 11th), US 28% (7th), UK 16% (2nd best) New Zealand 14% (best) (source)

% of people that did not get adequate care due to costs (fill prescription, visit doctor, get test, etc.) – US 37% (worst), Netherlands 22% (2nd worst), Canada 13%, UK 4% (best) (Source)

Number of annual deaths due to lack of insurance in the US – (2005 estimate, working age only) 44,789 (estimate according to this 2009 Harvard study)

2011 Health Expenditures/Capita – US $8,508 (worst, 11th), Canada $4,522 (6th), UK $3,405 (2nd) New Zealand $3,182 (best) (Source)

The difference in wait times is not huge, nor is the US the best. There appears to be little value for spending 2x more per capita. The only major area of difference is the wait times to see specialists for elective surgeries. As Beej67 has been arguing (as he's doing a better job arguing for universal healthcare than anything else), the availability of all these specialists comes with a cost/benefit ratio that appears slanted towards the cost side.

Also, see moltenmetal’s excellent post on the subject:

Wait times for essential procedures and emergency care are quite modest [in Canada] unless you live in a remote location. Most of the people waiting 2hrs or more for "emergency care" here aren't in need of emergency care- they are taking advantage of the free access to the emergency room we get here 24/7, either deliberately or as a precaution (for a sick child etc.). They're having their needs triaged against those of others who truly do need emergency care. When someone dies in an emergency room here because they were inappropriately triaged, it is a HUGE deal and national news- it happened to a First Nations man in Winnipeg recently and there was a hue and cry from sea to sea about it. Deaths while waiting for care here are truly rare.

What you fail to mention (besides linking your source) is that the stats you list for the UK are for elective surgeries. As molten describes, waits can be long for non-essential aspects but overall timely, available access to healthcare in universal healthcare is on-par with the US (some are better, some are worse). You have one system that cancels 50,000 elective operations per year and another that lets 45,000 die due to lack of insurance. Still not buying that boat ticket?

Regarding the heart surgery wait times in Sweden, it again ignores the fact that cardiovascular surgery, along with all types of surgery, are tiered based on risk. Long wait times do not necessarily equate to more deaths. A study by Queen Elizabeth II Health Center concluded “prolonged waiting was not associated with worse surgical outcomes”. Another study, found that 0.48% of patients scheduled for heart surgery died while waiting for heart surgery. Certainly anything higher than 0% is non-ideal but the number does not indicate a severe issue and there is no indication that this number is sufficiently higher than the US, especially if you factor in the number of patients that died because they were not adequately covered for heart surgery. While these are Canadian studies, it does highlight that, for the most part, the prioritizing of surgery is done well for the most part.

Improvements to the system are needed and universal healthcare is not perfect. However, A 2009 Nanos Research poll found that 86.2% of Canadians support “public solutions to make our public health care stronger”. A 2008 Strategic Counsel survey found 91% of Canadians preferred their healthcare system over the US system. In addition, a 2003 Gallup Poll found only 25% of Americans were ‘very” or “somewhat” satisfied with “the availability of affordable healthcare in the nation”, compared to 50% in the UK and 57% in Canada.

CBO Estimate
What? The number of uninsured people in the US is still going to be high. How does that possibly support your point? That’s an argument FOR universal healthcare and re-emphasizes that the ACA is not universal healthcare, so it supports MY point. You, like beej67, are doing a better job arguing for universal healthcare than against it. What do you think that number would be in a “free-market” system? Greater than zero?

”It may be cheaper up front, but what are you really paying after all the taxes and fees levied by the gov't?
…% of GDP is not the “up-front cost”. It’s the cost. And the US has the highest in the western world (by a long shot).
What is Canada really paying for healthcare? 11.2% of its GDP or $4,522 per capita
What is the UK really paying for healthcare? 9.4% of its GDP or $3,405 per capita
What is the US really paying for healthcare? 17.7% of its GDP or $8,508 per capita

Another interesting figure regarding the quality of healthcare in universal systems (with those "apathetic" doctors not giving you the care you need just to save money) versus the US:
[image

http://upload.wikimedia.org/wikipedia/commons/1/15/First-World-Infant-Mortality-Trends.jpg

]

 

[davefitz]

It is a curiosity that several US govt policies are contrary to what the majority of individuals seem to want. Single payer universal healthcare, an end to apparently infinite ( and undeclared) wars , "equal justice" ( as understood by the majority), the list goes on and on. Perhaps the root of the issue lies in the role that money is permitted to play in our "representative democracy".

A representative cannot be elected without obtaining and spending tens of millions of dollars in campaign funds, which are obtained from a few moneyed interests, who then obtain political favors ( at the 11th hour of an omnibus bill) which further their economic interests. Any legal challenge to individual instances of this formally permitted bribery is met with a stiff defense , since corporations are given all rights of a "person" under the law. In the case of the cash cow known as healthcare , the health insurance industry, pharmaceutical industry, AMA, medical products industry etc. can focus much more capital into "lobbying" (and other inducements) to obtain continued protection of their racket, to the detriment of the US public at large, as represented by the statistics provided earlier.

Restating statistics and facts apparently are not effective in changing US policy . IMO, either the legal system that allows moneyed interests to define policy needs to be amended, or a healthcare crisis would need to occur that can only be solved by a universal ,single payer healthcare system .

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

 

[moltenmetal]

In Canada we managed to get campaign finance reform that is unimaginable to Americans- with hard limits on contributions from individuals and corporations and unions- as a result of a pissing match between a former prime minister and his rival (his own finance minister at the time). In order to screw the other guy, Cretien did one of the greatest services for democracy that has ever been done here.

 

[glass99]

An aspect of the health care inflation which is not often discussed is that the industry does not have recessions. Most industries rely on recessions as a time for entrepreneurial search for new markets and efficiency. Have you ever heard of a doctor getting laid off? Where is the fear of failure? How do the weak performers get weeded out? When a hospital is underfunded, the hospital stuff ramp up the whining to 11 because they know they can get better elsewhere, but don't really make the changes necessary for long term cost control.

 

[IRstuff]

??? 20 hospitals closed as of Sept of this year:

http://www.beckershospitalreview.co...tal-closures-bankruptcies-so-far-in-2014.html

So, not recession proof.

TTFN
faq731-376

Need help writing a question or understanding a reply? forum1529

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

 

[beej67]

It is a curiosity that several US govt policies are contrary to what the majority of individuals seem to want. Single payer universal healthcare, an end to apparently infinite ( and undeclared) wars , "equal justice" ( as understood by the majority), the list goes on and on. Perhaps the root of the issue lies in the role that money is permitted to play in our "representative democracy".

Bingo.

And rconnor will also agree with that.

But then he will tell you that the solution is to have the (bought) government run everything. Which doesn't make a lot of sense. If our government was not bought, single payer healthcare would be a great way to go. He will continually bring up examples of other countries in which the government is not bought, which is like comparing a fresh apple to a rotten banana.

1) In other countries with single payer systems, the administrators of those single payer systems can decide that colonoscopies really aren't needed if there are other tests that are cheaper. That wouldn't work here, because the AMA would lobby congress to have Medicare pay for the expensive treatment.

2) In other countries with an actual free market (which is NOT what we have here) where the patient is paying with cash, the patient is free to seek the most affordable screening option, which is typically not a colonoscopy or is a colonoscopy in a doctor's office instead of a surgical center. That doesn't work here, because we're going to pass the costs on to our shared pool anyway, so the doctors brew up a more expensive version of the same thing to sell to the shared pool.

We do not have a free market here. We do not have universal healthcare here. We have the worst, most insidious blend possible of the two.

"Medicare For Everyone" is just putting a different skin on the rotten banana. It does not fix the rot.


Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[glass99]

IRStuff: Individual hospitals do occasionally close including the one in my neighborhood which they are turning into condo's, but the healthcare industry never contracts. Doctors are always employable, so have no incentive to make it work where they are. If you are an engineer at Chrysler which is failing and Ford is thriving and hiring, why bother attempting to fix things at Chrysler? Finding efficiency sucks.

 

[IRstuff]

http://www.transparency.org/cpi2014/results

you'll have to go to the site to see the entire map and legend

TTFN
faq731-376

Need help writing a question or understanding a reply? forum1529

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!