Health Care Reform - Universal/Public Option

[lynchjm24]

Originally Posted by SackAttack

I haven't spent a lot of time following the health care debate. I didn't expect it to come up this soon in his term.

But one thing I have heard in soundbites and in passing on the radio is this idea that government-sponsored health care would drive private insurers out of business because they wouldn't be able to compete with the lower costs the government would be able to achieve on behalf of a much larger volume of insured.

Is that really a problem? Is the health and well-being of the general public really an area where the profit motive should be the primary motive?

The for profit insurance companies do much more to lower the health care costs in this country then any other entity.

It's a low margin business without which you'll see an explosion in costs.

Non-profit plans have no reason to lower claim costs and it shows in their claim experience and underwriting cycles.

Of course some people like Medicare. There is no patient management and there is no party concerned with controlling their costs. If anyone thinks Medicare is 'cheap' then they are out of their minds, the out of pocket expenses when you get to retirement age are low, but in no way is it 'cheap'.

[JPhillips]

Originally Posted by rowech

Difference being that those are state fees. If the state of Ohio chooses to get into this mess of health care for all, develops a plan, passes, etc. I'd still be upset but I would accept it because it comes from the state I live in and not the federal government.

I'll be honest, I don't get that at all. If you believe you shouldn't be forced to buy insurance, why does it matter if that mandate comes from Washington or your local condo board?

[JPhillips]

Originally Posted by lynchjm24

The for profit insurance companies do much more to lower the health care costs in this country then any other entity.

It's a low margin business without which you'll see an explosion in costs.

Non-profit plans have no reason to lower claim costs and it shows in their claim experience and underwriting cycles.

Of course some people like Medicare. There is no patient management and there is no party concerned with controlling their costs. If anyone thinks Medicare is 'cheap' then they are out of their minds, the out of pocket expenses when you get to retirement age are low, but in no way is it 'cheap'.

It may not be cheap, but Medicare does what it does cheaper than similar private insurance.

[SteveMax58]

Originally Posted by JPhillips

I'll be honest, I don't get that at all. If you believe you shouldn't be forced to buy insurance, why does it matter if that mandate comes from Washington or your local condo board?

Same as the general advocacy for allowing states' rights to pass other laws or taxes...if you do not like that particular state's social engineering, you have the option to move. If you can't afford to move, then well, you're likely on the taking end of the issue anyway.

[rowech]

Originally Posted by JPhillips

I'll be honest, I don't get that at all. If you believe you shouldn't be forced to buy insurance, why does it matter if that mandate comes from Washington or your local condo board?

Crazy little thing called The Constitution.

[albionmoonlight]

I fear socalized/single payer health care.

I think that it is the end-game of the current health care bill(s).

I wish that the GOP was in a more organized place policy-wise and a less beat-up place reputation-wise so that it could provide a compelling alternative that the public would accept.

I think that, for lack of an organized, competent opposition, the Democrats will end up passing something that ultimately makes life just a little worse for my grandkids than it needs to be.

The sooner the GOP gets Sarah Palin/Tea Parties/Joe the Plumber out of its system, the better for this country.

[SteveMax58]

Originally Posted by albionmoonlight

The sooner the GOP gets Sarah Palin/Tea Parties/Joe the Plumber out of its system, the better for this country.

+1 to that. Hard to make compelling arguments of a serious nature when you keep trying to defend non-serious people and candidates.

[JPhillips]

Originally Posted by rowech

Crazy little thing called The Constitution.

But you weren't complaining about the implementation of the law, but the proposed law itself. I get the state's rights argument, but I don't understand how an injustice at the federal level is somehow less of an injustice at the state or local level.

[rowech]

Originally Posted by JPhillips

But you weren't complaining about the implementation of the law, but the proposed law itself. I get the state's rights argument, but I don't understand how an injustice at the federal level is somehow less of an injustice at the state or local level.

Because the federal government has no business doing what they're doing. The federal government has destroyed the United States because they keep overstepping their bounds.

[JPhillips]

Destroyed the United States? But this is getting off track, so I'll end my part of it.

[flere-imsaho]

Originally Posted by rowech

As for your 2nd part, it is my right to not take health insurance if I don't want it. Period.

Then it should be my right to not have to pay for your ER care when you drive your car into a tree.

[rowech]

Originally Posted by flere-imsaho

Then it should be my right to not have to pay for your ER care when you drive your car into a tree.

100% agree but you won't have to because I have quality insurance.

It's the principle of the matter at hand. You have a massive government already and now they are telling citizens what they MUST do and if they don't, they will be PENALIZED. How can anyone not see that as wrong and against the law? People want all these things from the government and they are all coming with a heavy price financially as well as in freedoms. The line keeps getting blurred more and more and people are willing more and more to adjust that line just a little bit here and a little bit there.

We have become exactly what was setup to try and avoid at all costs.

[flere-imsaho]

And thus when your hospital and rehab bills are $500,000+, you've effectively been removed from society as an effective and upwardly-mobile person, a net loss to society.

[Mizzou B-ball fan]

Originally Posted by rowech

100% agree but you won't have to because I have quality insurance.

It's the principle of the matter at hand. You have a massive government already and now they are telling citizens what they MUST do and if they don't, they will be PENALIZED. How can anyone not see that as wrong and against the law? People want all these things from the government and they are all coming with a heavy price financially as well as in freedoms. The line keeps getting blurred more and more and people are willing more and more to adjust that line just a little bit here and a little bit there.

We have become exactly what was setup to try and avoid at all costs.

I agree that the current proposition is way out of hand. Requiring coverage is nuts. Of course, the counter other posters are presenting does pose a legitimate point. You still have the issue that the Democrats feel everyone is entitled to medical care. Would the people who don't want coverage be forced to sign a waiver saying that they can be refused care if they are injured/sick (i.e. the government/taxpayers won't foot the bill)?

[JPhillips]

It's not just the emergency room scenario that's the problem. End of life care is where most spending happens. To pay for all that spending, those that are younger and healthy are subsidizing things. There's a real problem in allowing people to only pay into the healthcare system when they are more likely to take more out of the system than they put in.

[SteveMax58]

Originally Posted by JPhillips

It's not just the emergency room scenario that's the problem. End of life care is where most spending happens. To pay for all that spending, those that are younger and healthy are subsidizing things. There's a real problem in allowing people to only pay into the healthcare system when they are more likely to take more out of the system than they put in.

While I am anti-government as a default view due to the inevitable f-ing up of the system(and unintended consequences) they are likely to cause...I do agree with this in principle. My primary argument(s) with socialized medicine are really the following:

(1) Lowering Health Care costs on the surface, means lowering the income of US taxpayers (whether that be corporations or individuals working for them)...we have bigger fish to fry at the moment in order to reduce costs for everybody...like energy costs

(2) I would prefer this to be something that states implement. That way...we can "fire" the people in charge of these programs if they begin to bankrupt us. At the Fed level...you can't fire Senator "x" from Michigan (hypothetically) who heads the Nationalized Health Care oversight committee...you need the people in Michigan to do this for you. See our banking & finance committees for such wonderful examples.

(3) This sounds like a way to get health care coverage legalized for illegal workers. Since EVERYBODY is covered (whether you want it or not)...why would anybody need to prove coverage when going to the hospital/Dr office? I dont have the details of the plan in front of me...and this may possibly be addressed somehow...but this is just one of MANY potential abuses of the system I can see.

(4) Once you add a program to the Fed's authority...it NEVER GOES AWAY...EVA!!!

[Mizzou B-ball fan]

Originally Posted by SteveMax58

(3) This sounds like a way to get health care coverage legalized for illegal workers. Since EVERYBODY is covered (whether you want it or not)...why would anybody need to prove coverage when going to the hospital/Dr office? I dont have the details of the plan in front of me...and this may possibly be addressed somehow...but this is just one of MANY potential abuses of the system I can see.

This is a huge problem in the current bill. The number of illegals in the country will continue to escalate in the coming years barring a crackdown. As it is, American taxpayers will continue to foot the bill for these people.

[lungs]

Originally Posted by SteveMax58

(2) I would prefer this to be something that states implement. That way...we can "fire" the people in charge of these programs if they begin to bankrupt us. At the Fed level...you can't fire Senator "x" from Michigan (hypothetically) who heads the Nationalized Health Care oversight committee...you need the people in Michigan to do this for you. See our banking & finance committees for such wonderful examples.

(4) Once you add a program to the Fed's authority...it NEVER GOES AWAY...EVA!!!

I think these two points go hand-in-hand. Haven't we already added enough to the Fed's authority that it makes it damn near impossible for the states to implement anything on their own?

Ie: We already pay out of the ass for the Federal Government so the states can't be all that effective in their own governance.

The federal government in this country is already too damned powerful for the states to do much of anything. And nothing short of completely dismantling the United States will be able to change that. And I don't think that's the worst idea in the world, as unpopular a view as it may be. Big government, big corporations all suck donkey balls. So do big countries.

[RainMaker]

Originally Posted by Mizzou B-ball fan

I agree that the current proposition is way out of hand. Requiring coverage is nuts. Of course, the counter other posters are presenting does pose a legitimate point. You still have the issue that the Democrats feel everyone is entitled to medical care. Would the people who don't want coverage be forced to sign a waiver saying that they can be refused care if they are injured/sick (i.e. the government/taxpayers won't foot the bill)?

It's an interesting thought, but remember that Republicans are the ones who are against that stuff. They are the ones that don't believe you should be allowed to commit suicide or be pulled off a feeding tube when your brain is mush. I'd be for that stance but it seems to contradict some Republican beliefs.

The other problem is that people don't have a problem opting out of this stuff when they are healthy. But when that person breaks their leg or gets an insurmountable pain in their head one night, they are probably going to do everything they can to make it stop. In theory having people "opt-out" is nice, but in reality, you aren't going to give a shit what form you signed when you feel like you're having a heart attack.

[RainMaker]

Originally Posted by Mizzou B-ball fan

I agree that the current proposition is way out of hand. Requiring coverage is nuts. Of course, the counter other posters are presenting does pose a legitimate point. You still have the issue that the Democrats feel everyone is entitled to medical care. Would the people who don't want coverage be forced to sign a waiver saying that they can be refused care if they are injured/sick (i.e. the government/taxpayers won't foot the bill)?

I don't get this issue with everyone being entitled to health care. We all feel like we are entitled to police protection, fire protection, military protection, as well as roads, bridges, and courthouses.

Isn't health care just as important as a police force in your town? Or having a military to fight off attacks from other countries? I understand arguments on costs and the system, but to act like it's wrong to feel entitled to health care would seem to be along the same lines of being upset that we are entitled to basic protections from our local police department.

[SteveMax58]

Originally Posted by RainMaker

Isn't health care just as important as a police force in your town?

Yes...with the caveat of...define "Health Care".

To this analogy...police will come in an emergency situation if you call or need help due to a break-in, etc...but they will not hangout and act as your bodyguard every weekend because the drunk neighbor is a bit volatile and might be inclined to fight somebody who happens to be walking by his yard. They'll tell you (w/ rare exceptions I realize)...call us when the situation requires emergency response.

Dramatic difference, in many people's minds, between having 911 ER services for truly emergency care services and the idea of "regular" checkups with all of the associated "precautionary" tests doctors may feel inclined to send you on..."just to be safe". A government-sponsored HC system, on the surface, has no real incentive nor cost-effective mechanism to limit this type of activity.

[JPhillips]

Originally Posted by SteveMax58

Yes...with the caveat of...define "Health Care".

To this analogy...police will come in an emergency situation if you call or need help due to a break-in, etc...but they will not hangout and act as your bodyguard every weekend because the drunk neighbor is a bit volatile and might be inclined to fight somebody who happens to be walking by his yard. They'll tell you (w/ rare exceptions I realize)...call us when the situation requires emergency response.

Dramatic difference, in many people's minds, between having 911 ER services for truly emergency care services and the idea of "regular" checkups with all of the associated "precautionary" tests doctors may feel inclined to send you on..."just to be safe". A government-sponsored HC system, on the surface, has no real incentive nor cost-effective mechanism to limit this type of activity.

But police do a ton of preventive work, for most it's the bulk of their job. Walking/driving a beat, talking to people in the neighborhood, doing school presentations, etc. are all preventive work. The framed "broken window" policing in NYC was really largely about how preventive police work can save time and money before small crimes become large crimes.

[gstelmack]

However, we already have this. One of the big wastes right now is folks without insurance going to the ER for colds and the like because it is the only place they can get checked to make sure it isn't something much more serious. Not that I'm a huge fan of the government taking this over for fear it will expand beyond the ER, but I also agree with the points that health insurance has already added a huge layer of bureaucracy and we already have folks tying up key services like ER for mundane issues.

I think the concept of co-pays needs to continue so there is SOME check on willy-nilly use of services.

[SteveMax58]

Originally Posted by gstelmack

I think the concept of co-pays needs to continue so there is SOME check on willy-nilly use of services.

I agree with the concept of higher co-pays to discourage over-zealous usage...but then...can't private insurance make this cost/benefit analysis for themselves?

[gstelmack]

Originally Posted by SteveMax58

I agree with the concept of higher co-pays to discourage over-zealous usage...but then...can't private insurance make this cost/benefit analysis for themselves?

I was specifically talking about uninsured folks heading to the ER. We need a way for them to go see a "normal" doctor, but we also need to make sure they pay SOMETHING so they don't go whenever they get a runny nose.

[SteveMax58]

Originally Posted by JPhillips

But police do a ton of preventive work, for most it's the bulk of their job. Walking/driving a beat, talking to people in the neighborhood, doing school presentations, etc. are all preventive work. The framed "broken window" policing in NYC was really largely about how preventive police work can save time and money before small crimes become large crimes.

It's hard to make complete apples-to-apples comparisons between police & medical...but doctors do those same things as well only not on the taxpayer dime. And to take it a step further...the police exist to allow for any orderly society that enables people to feel safe enough to provide goods and services. So...police forces have a much more encompassing affect on society than just literally arresting the bad guy that robbed 'me'.

I just want to reiterrate...I'm not totally against some form of HC for everybody...I just don't like the concept of the Federal government doing it based on some of the reasons I listed earlier...and a few more I could list off when I get more time later.

[RainMaker]

Originally Posted by SteveMax58

Yes...with the caveat of...define "Health Care".

To this analogy...police will come in an emergency situation if you call or need help due to a break-in, etc...but they will not hangout and act as your bodyguard every weekend because the drunk neighbor is a bit volatile and might be inclined to fight somebody who happens to be walking by his yard. They'll tell you (w/ rare exceptions I realize)...call us when the situation requires emergency response.

Dramatic difference, in many people's minds, between having 911 ER services for truly emergency care services and the idea of "regular" checkups with all of the associated "precautionary" tests doctors may feel inclined to send you on..."just to be safe". A government-sponsored HC system, on the surface, has no real incentive nor cost-effective mechanism to limit this type of activity.

In the same vain, an insurance company will often reject precautionary tests that doctors feel are necessary. I guess the goal would be finding something in the middle to avoid reckless tests while making sure people aren't stiffed on the ones they need.

[SackAttack]

Originally Posted by lynchjm24

The for profit insurance companies do much more to lower the health care costs in this country then any other entity.

Lower them for whom, though? That's the key thing there. My hunch is, cost savings don't get passed on to the end user, because - as you said - the profit margins are thin in the first place. Additionally, they have shareholders, who expect a return on their investment. If sufficient cost savings can't be realized, you're going to see an increase in premiums to generate enough income to satisfy the shareholders. Where has that benefited the individual in need of health care?

Besides which, how does the existence of the profit motive help to lower those costs any further than the bargaining power of the collective would in the first place? It might provide greater motivation on the part of the insurer, but what actual, tangible effect does it have?

[SteveMax58]

Originally Posted by gstelmack

I was specifically talking about uninsured folks heading to the ER. We need a way for them to go see a "normal" doctor, but we also need to make sure they pay SOMETHING so they don't go whenever they get a runny nose.

I get your point but I think this is where 2 things come into play...

1) Allowing Hospitals the authority to diagnose, not treat, release, and subsequently bill patients (visit costs) who they (ER docs) do not believe have a "medical emergency".

2) Limiting lawsuit payouts across the board...and not allowing lawsuit payouts at all for uninsured patients. You certainly can allow proven, gross negligence to be prosecuted...but you dont get paydays for playing roulette at the ER.

Again...I'll state that if a given state wants to implement HC across the board, then fine...there is at least some degree of accountability to it. The Fed level doing anything? There is of course, none.

[RainMaker]

Originally Posted by lynchjm24

It's a low margin business without which you'll see an explosion in costs.

The margin argument is kind of bullshit. There are a lot of businesses that play with small margins. Profits are what matters and ultimately the health insurance profits have been soaring over the past decade.

There is literally no competition in the health insurance space and these companies are just hoarding the profits (not passing any savings on to consumers).

The private sector option only works if there is more competition. There is no completely free market strategy that can work since they have a monopoly at the moment. You'd have to have the government help get other companies off the ground or split up the large ones to actually have a competitive market with companies competing with one another.

[flere-imsaho]

Originally Posted by gstelmack

I was specifically talking about uninsured folks heading to the ER. We need a way for them to go see a "normal" doctor, but we also need to make sure they pay SOMETHING so they don't go whenever they get a runny nose.

While I agree that the need for an easy/cheap route to see a "normal" doctor for non-emergencies is very real, I'm skeptical about the number of people who go to the ER for a runny nose (or similar minor complaint). In fact, I'm reasonably sure that the greater impact on hospital finances comes from uninsured people who, due to having no route to preventative care, come into the ER for taxpayer-funded critical/urgent care.

[Autumn]

This great post has not had enough attention.

Originally Posted by kcchief19

Having studied universal health care for 20 years, I can say unequivocally I'm 100 percent in favor of a universal health care system. There is little doubt in my mind that it would work, and evidence worldwide supports that.

The challenge to me has always been to develop a system that doesn't supplant privately owned companies. I don't think it is in our best financial interest to create a system to replace what we have, only overlay a safety net that will protect people with jobs without insurance, elderly, children and even people in between jobs.

The system Obama is advocating makes the most sense for me. I work for a small business, and insurance is a killer cost for us. You would be hard pressed to argue to me that the insurance industry is not highly collusive. We shop around every year and it's amazing how consistent the rates are from company to company. Periodically you'll find a company who will offer you a savings to switch but will immediately jump your rates as quickly as possible to the same level you were at before. Having an efficient public entity that could compete with private insurance would be help lower costs for everyone.

I do believe a government run insurance company would work. In fact, it already does. Medicare provides insurance coverage for the federal government and including Congress. If it's good enough for them, it should be good enough for us. Are there problems with Medicare? Sure. Are there problems with private insurance? Absolutely. I love the commercials saying that universal health care would put a bureaucrat between you and your doctor. Um, I have that already. Frankly, when it comes to health care I don't care if it's a tax or a premium -- I just want to know which one is cheaper.

For the conservative types, I say two things:

One, the current system of employer-based health care is notoriously discriminatory toward younger workers and men. My employer picks up the tab for our premiums. My annual premium is less than $2,400. Women my same age have a premium at least twice as high because they are of child bearing age. I work with one guy whose annual premium is just under $11,000. But we get treated the same. In essence, my office has it's own "socialized" medicine program. However, if my company could save money by going with a government plan, it's a win/win for us.

Secondly, I don't see how you can be a social conservative and not be in favor of universal health care, unless you just don't read your Bible. Matthew 25:40 says, "And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done unto one of the least of these my brethren, ye have done unto me." I'm not highly religious. I was raised Catholic but not inside the church. It would be more fair to say I was raised with a Catholic ethic. I think it's a good moral system to have. Tending to the least among us is one of them ost basic and essential tenants of the teachings of Jesus. If you believe in the Bible but don't believe in basic health care for all, to me you're a hypocrite.

Obama's proposal is the most sensible plan I've seen come along in my lifetime. Yes, we'll have to pay for it. But we're paying for it already. The most expensive health care service we have is emergency room care. The biggest burden of emergency rooms are people ending up there because they didn't get preventive care. It's a huge economic boom for the nation -- we save money on health care, people don't get as sick, we boost productivity. Plus, you would completely eliminate Medicad, which I would argue is much more inefficient and maligned than Medicare is.

[lynchjm24]

Originally Posted by JPhillips

It may not be cheap, but Medicare does what it does cheaper than similar private insurance.

You ever stop to see how they do it?

They dictate the reimbursements to the providers and facilities. If they paid for the whole system there wouldn't be anyone going into practice.

[lynchjm24]

Originally Posted by SackAttack

Lower them for whom, though? That's the key thing there. My hunch is, cost savings don't get passed on to the end user, because - as you said - the profit margins are thin in the first place. Additionally, they have shareholders, who expect a return on their investment. If sufficient cost savings can't be realized, you're going to see an increase in premiums to generate enough income to satisfy the shareholders. Where has that benefited the individual in need of health care?

Besides which, how does the existence of the profit motive help to lower those costs any further than the bargaining power of the collective would in the first place? It might provide greater motivation on the part of the insurer, but what actual, tangible effect does it have?

Health insurance companies generally don't pay dividends to shareholders. The large American insurance companies have moved towards focusing on wellness and preventative services.

The cost savings are passed along inherently in the course of doing business. For profit insurance companies have an incentive to find ways to lower claim costs.

The bargaining power of the collective single payer system in this country would be a terrible thing. The term is a monsopoly, sort of the opposite of a monopoly, instead of one supplier setting the market, one purchaser would. With only one purchaser good luck finding doctors and facilities because they would no longer be able to afford to exist. You'd lose all innovation in both the medical and pharmacy fields.

The public does not understand how health insurance works. Insurance companies do not decide generally decide what is and what isn't covered. Your employer picks your benefits, that simple fact alone is lost on most people. Most people who work at decent sized corporations aren't even insured by their carrier, they are insured by their employer. The insurance company is merely administering the benefits as specified by the company.

A single payer system would be a complete total utter disaster. Give Americans less of a reason to stay healthy and what do you think is going to happen?

The idea of first dollar coverage is where the system came off the tracks, moving more people towards it certainly isn't the right solution.

[lynchjm24]

Originally Posted by RainMaker

There is literally no competition in the health insurance space and these companies are just hoarding the profits (not passing any savings on to consumers).

This is funny. Come do my job for a day and tell me there is no competition in the private sector health insurance world. It's 100% completely totally demonstrably false and you are wrong as someone can be.

[SackAttack]

Originally Posted by lynchjm24

You ever stop to see how they do it?

They dictate the reimbursements to the providers and facilities. If they paid for the whole system there wouldn't be anyone going into practice.

If you're going into medicine for the paydays, you're establishing your practice for the wrong reason.

Now, I guess maybe that ties back into the whole "med school is so $!*ing expensive that health care professionals need to make big bucks to justify going into medicine." I can buy that - but it seems like that's another cost you could potentially subisidize if, as the government, you are setting up universal health care. Help keep the doctors from having a backbreaking debt burden to deal with, and perhaps you can help reduce costs there, as well as making it easier for people who want to go into medicine to help people to actually realize that goal.

[lynchjm24]

It's pretty simple math.

Your larger (Wellpoint, United, etc.) for-profit insurance companies collect premium on a group they insure:

About 81-83% of that premium goes towards paying claims.
About 1-2% of it goes towards state taxes and state assessments.
About 2-3% of it goes towards paying insurance brokers.
About 10% of it goes toward SG&A.
There is about 5-6% left over pre-FIT in margin.

Groups that are over about 100 people have a good portion of their premium set by exactly how their experience runs. If your company has sick employees who utilize you have high rates, if your company has healthy employees who don't utilize you have low rates.

There is no collusion, there is competition. The reason why your rates are the same between companies is because the vast majority of the premium is spent on your groups claims. Those don't drastically change because you changed carriers.

[gstelmack]

Originally Posted by lynchjm24

The public does not understand how health insurance works. Insurance companies do not decide generally decide what is and what isn't covered. Your employer picks your benefits, that simple fact alone is lost on most people. Most people who work at decent sized corporations aren't even insured by their carrier, they are insured by their employer. The insurance company is merely administering the benefits as specified by the company.

Which leads to a couple of issues:

First off, the insurance company is specifying the rates for those services, which drives what the employer can and cannot afford to pay for. So yes, the insurance company has a lot of say by simply making certain coverages exhorbitant.

Second, the insurance company is setting risk levels on a much smaller group of folks. Rather than it being the risks for, say, a large chunk of North Carolina, my rates are set based on the risks at the company I work for. It does not spread out the costs of healthcare like it is supposed to.

I'm under BCBS, a non-profit which generally provides great services. They do so because they charge an arm and a leg, and then have to find some way to spend all that cash (like when they were trying to become for-profit and spent like $800K+ for a big tent at one of the golf tourneys at Southern Pines...) to remain non-profit. We got our rates upped big-time one year because they had to pay for upgrading their computer systems to stop using social security numbers as ID (which they were never supposed to do in the first place), then it took them like 4 years before they stopped using them.

[gstelmack]

Originally Posted by lynchjm24

About 81-83% of that premium goes towards paying claims.

And a lot of that amount goes toward dealing with all the paperwork at your medical provider associated with attempting to recover those claims. There is gross inefficiency in the system, not to mention fraud.

[lynchjm24]

Originally Posted by SackAttack

If you're going into medicine for the paydays, you're establishing your practice for the wrong reason.

Now, I guess maybe that ties back into the whole "med school is so $!*ing expensive that health care professionals need to make big bucks to justify going into medicine." I can buy that - but it seems like that's another cost you could potentially subisidize if, as the government, you are setting up universal health care. Help keep the doctors from having a backbreaking debt burden to deal with, and perhaps you can help reduce costs there, as well as making it easier for people who want to go into medicine to help people to actually realize that goal.

Here on planet Earth, the sort of people I'd want taking care of me are the sort of people who are well compensated. If they aren't getting paid as doctors they will go do something else.

Pretending something else to be true is silly.

Look at the people already in medicine and how they are changing based on the way they earn.

[lynchjm24]

Originally Posted by gstelmack

And a lot of that amount goes toward dealing with all the paperwork at your medical provider associated with attempting to recover those claims. There is gross inefficiency in the system, not to mention fraud.

The 81-83% goes towards paying claims. Some of those claims are fraudulent, some of the SG&A goes towards recouping the fraudulent dollars. A single payer is somehow going to make fraud magically disappear?

[lynchjm24]

Originally Posted by gstelmack

First off, the insurance company is specifying the rates for those services, which drives what the employer can and cannot afford to pay for. So yes, the insurance company has a lot of say by simply making certain coverages exhorbitant.

Second, the insurance company is setting risk levels on a much smaller group of folks. Rather than it being the risks for, say, a large chunk of North Carolina, my rates are set based on the risks at the company I work for. It does not spread out the costs of healthcare like it is supposed to.

So it's the insurance companies fault that things like Advanced Reproductive Therapies are expensive?

Yes, on smaller groups the demographics of the group come into play and you are going to get increases that bring the populations of the smaller groups into one pool. Your initial rates are determined by the demographics of your group, after that on smaller groups you are getting a somewhat normalized increase based on the large population. Those rates are filed with state regulators in a lot of places and there isn't a lot of room for 'gray'.

[SackAttack]

Originally Posted by lynchjm24

Here on planet Earth, the sort of people I'd want taking care of me are the sort of people who are well compensated. If they aren't getting paid as doctors they will go do something else.

Pretending something else to be true is silly.

Look at the people already in medicine and how they are changing based on the way they earn.

I repeat, someone who's more concerned about getting paid than about treating his or her patients is in the business for the wrong reasons entirely. I'm all for paying them well, but there needs to be a measure of sanity in the system. Effectively paying them on commission based on the tests they order for their patients is insane.

And, as I say, finding some way to address the economic barriers to entry in the profession would go some distance towards ameliorating some of the pay concerns. Or is that house in the Hamptons a deal-breaker for a would-be doctor no matter what?

[RainMaker]

Originally Posted by lynchjm24

This is funny. Come do my job for a day and tell me there is no competition in the private sector health insurance world. It's 100% completely totally demonstrably false and you are wrong as someone can be.

The top 2 insurance companies in California own 60% of the marketshare. The top 5 in Maine own 98%. There are maybe a handful of companies to choose from wherever you live. Most of the small companies have been eaten up by the big ones in mergers. If you go to any of the major metropolitan areas in the country, a couple companies dominate.

I'm in Chicago and I had 3 choices for our business health insurance. One of them wasn't really an option since they didn't really offer what we wanted. Where are all these options you know about? I see the same big names in every conversation, no one else.

[lynchjm24]

Originally Posted by RainMaker

The top 2 insurance companies in California own 60% of the marketshare. The top 5 in Maine own 98%. There are maybe a handful of companies to choose from wherever you live. Most of the small companies have been eaten up by the big ones in mergers. If you go to any of the major metropolitan areas in the country, a couple companies dominate.

I'm in Chicago and I had 3 choices for our business health insurance. One of them wasn't really an option since they didn't really offer what we wanted. Where are all these options you know about? I see the same big names in every conversation, no one else.

5 is an issue? How many do you think can exist? It's a low margin business with a high cost of entry. There aren't that many employers in Maine how many do you think could build enough membership to sustain a reasonable risk pool and an economy of scale?

California has Blue Cross of CA, Blue Shield of CA, Pacificare (United), Aetna, Kaiser, CIGNA plus others.

I'm not as familiar with Chicago or what you were looking for but I can assure there are more then 3 companies doing business there.

[lynchjm24]

Originally Posted by SackAttack

I repeat, someone who's more concerned about getting paid than about treating his or her patients is in the business for the wrong reasons entirely. I'm all for paying them well, but there needs to be a measure of sanity in the system. Effectively paying them on commission based on the tests they order for their patients is insane.

And, as I say, finding some way to address the economic barriers to entry in the profession would go some distance towards ameliorating some of the pay concerns. Or is that house in the Hamptons a deal-breaker for a would-be doctor no matter what?

That's great to have that pie in the sky mentality. The reality is that if you don't pay doctors those talented people will do something else.

[Swaggs]

It would be interesting to see both physician and patient satisfaction surveys from different nations. The only one I could find on google was a Foxnews article on patient satisfaction, from 2004, indicating that the U.S. trailed almost all other industrialized nations in a number of different areas.

[JPhillips]

Originally Posted by lynchjm24

Health insurance companies generally don't pay dividends to shareholders. The large American insurance companies have moved towards focusing on wellness and preventative services.

The cost savings are passed along inherently in the course of doing business. For profit insurance companies have an incentive to find ways to lower claim costs.

The bargaining power of the collective single payer system in this country would be a terrible thing. The term is a monsopoly, sort of the opposite of a monopoly, instead of one supplier setting the market, one purchaser would. With only one purchaser good luck finding doctors and facilities because they would no longer be able to afford to exist. You'd lose all innovation in both the medical and pharmacy fields.

The public does not understand how health insurance works. Insurance companies do not decide generally decide what is and what isn't covered. Your employer picks your benefits, that simple fact alone is lost on most people. Most people who work at decent sized corporations aren't even insured by their carrier, they are insured by their employer. The insurance company is merely administering the benefits as specified by the company.

A single payer system would be a complete total utter disaster. Give Americans less of a reason to stay healthy and what do you think is going to happen?

The idea of first dollar coverage is where the system came off the tracks, moving more people towards it certainly isn't the right solution.

How do you square this doomsday scenario with the fact that the rest of the industrialized world has universal healthcare and there are still doctors, people aren't terribly unhealthy, and they still have hospitals? Even if you disagree with a single payer system, this Chicken Little routine just rings hollow.

[SackAttack]

Originally Posted by lynchjm24

That's great to have that pie in the sky mentality. The reality is that if you don't pay doctors those talented people will do something else.

Destroy Wall Street? Chase ambulances? Drive Fortune 500 companies into the ground?

I mean, this is the vibe I'm getting from you here, that nobody would ever be a doctor unless mad bank is involved. What, precisely, are the people who would leave medicine if they aren't getting Paid (with the capital P, natch) going to go do instead?

Then there's the other half of the equation - if they start getting compensated for their treatment of people who, historically, have been uninsured, isn't that going to create a release valve in terms of costs passed on to other people?

Look, doctors put long hours doing work that generally only gets remembered if they fuck up. I get that. They deserve to get paid for that work. I don't argue with that. But there has got to be a better way to get them that compensation than to work the system through tests and other commission-like shenanigans because there's a leak somewhere else in the system that's costing them money.

[Swaggs]

Originally Posted by SackAttack

Destroy Wall Street? Chase ambulances? Drive Fortune 500 companies into the ground?

I mean, this is the vibe I'm getting from you here, that nobody would ever be a doctor unless mad bank is involved. What, precisely, are the people who would leave medicine if they aren't getting Paid (with the capital P, natch) going to go do instead?

Then there's the other half of the equation - if they start getting compensated for their treatment of people who, historically, have been uninsured, isn't that going to create a release valve in terms of costs passed on to other people?

Look, doctors put long hours doing work that generally only gets remembered if they fuck up. I get that. They deserve to get paid for that work. I don't argue with that. But there has got to be a better way to get them that compensation than to work the system through tests and other commission-like shenanigans because there's a leak somewhere else in the system that's costing them money.

For the most part, the doctors who are getting "Paid" are very good businessmen (as well as very good physicians). I would venture to guess that the majority of physicians work in rural locations and/or for universities and get paid considerably less than most people would suspect (and practice for the love of their craft rather than for the money).

I think a mass exodus of doctors, due to a public option, is a Chicken Little scenario. The profession is so well respected/prestigious, reliably pays well, and offers a pretty good lifestyle (for the most part), so I wouldn't expect the quantity or quality of med school applicants to be hurt at all (what you might see is a considerable influx of foreign doctors coming to the U.S. to help offset the increase in patients).