Healthcare/Health Insurance: what is the actual problem?

[iatrogenic]

In India, the cost for this operation ranges from $4000-$7000.
https://www.medicaltourismco.com/nephrectomy-surgery-abroad/

Your statement that lowering price to create more sales means mor profit is often erroneous. Once your per unit cost (in this case the average cost to insure someone) falls below the per unit premium, you begin losing additional money for each person you add on.

In the case of health care, the more broad the coverage, the more sickly (less insurable) the additional people are likely to be and the more I'll need to hike the price for the entire pool to allow profit.

I bet the cost of a nephrectomy in Botswana is even cheaper, but I suggest you check statistics on operative and post operative mortality rates, and post operative infection rates before you hustle off to a foreign country to get your Kidney removed.

My anecdotal experience, as someone that has been badly injured in a foreign country that had universal health care, is that you don't want anything to do with those hospitals unless absolutely necessary.

I have read your second and third paragraphs a few times, but I'll be damned if I can make any sense of them.

 

[Musburger1]

I bet the cost of a nephrectomy in Botswana is even cheaper, but I suggest you check statistics on operative and post operative mortality rates, and post operative infection rates before you hustle off to a foreign country to get your Kidney removed.

My anecdotal experience, as someone that has been badly injured in a foreign country that had universal health care, is that you don't want anything to do with those hospitals unless absolutely necessary.

I have read your second and third paragraphs a few times, but I'll be damned if I can make any sense of them.

If you haven't noticed, half the doctors in the US are Indian; or at least it seems that way. The equipment they use in India is the same thing we use here. Cat-scans, etc. The prices in India aren't lower because the quality is poorer. The prices are lower because you pay out of pocket vs here where he have both a vast insurance bureaucracy and a vast government bureaucracy (medicare/medicaid).

In America, you not only pay ever rising premiums for your private health care (insurance), you pay another 2.9% of your wages for public health care (Medicare). So if your family earns $100,000 per year in wages, you are paying $2,900 for somebody else's health care. Half of this comes from payroll deduction and the rest is paid by your employer.

Note the divergence in health care expenditures vs GDP beginning around 1965. What happened this year?
(Link).

President Lyndon B. Johnson signed the Medicare and Medicaid programs into law in 1965, creating publicly run insurance for the elderly and the poor. Medicare was later expanded to cover people with disabilities, end-stage renal disease, and ALS.

​

 

[iatrogenic]

If you haven't noticed, half the doctors in the US are Indian; or at least it seems that way. The equipment they use in India is the same thing we use here. Cat-scans, etc. The prices in India aren't lower because the quality is poorer. The prices are lower because you pay out of pocket vs here where he have both a vast insurance bureaucracy and a vast government bureaucracy (medicare/medicaid).

In America, you not only pay ever rising premiums for your private health care (insurance), you pay another 2.9% of your wages for public health care (Medicare). So if your family earns $100,000 per year in wages, you are paying $2,900 for somebody else's health care. Half of this comes from payroll deduction and the rest is paid by your employer.

Note the divergence in health care expenditures vs GDP beginning around 1965. What happened this year?
(Link).

President Lyndon B. Johnson signed the Medicare and Medicaid programs into law in 1965, creating publicly run insurance for the elderly and the poor. Medicare was later expanded to cover people with disabilities, end-stage renal disease, and ALS.

​

But the prices in India are not lower, as shown by the nephrectomy example. But feel free to zip on over to India and have all of that Indian health care you can afford.

Yep, I'm familiar with the cost of health care and payroll deductions. Still waiting for the details on the declining lifespans of Americans though.

 

[Musburger1]

But the prices in India are not lower, as shown by the nephrectomy example. But feel free to zip on over to India and have all of that Indian health care you can afford.

Yep, I'm familiar with the cost of health care and payroll deductions. Still waiting for the details on the declining lifespans of Americans though.

Did you not read my post where I provided a linked showing the cost of the operation in India ranges from $4,000 to $7,000 as opposed to your examples of $60,000 and $10,000?


This article from December reports that US life expectancy has now begun to reverse.

An American born in 2015 is expected to live 78 years and 9½ months, on average, according to preliminary data released Thursday by the Centers for Disease Control and Prevention. An American born in 2014 could expect to live about month longer, and even an American born in 2012 would have been expected to live slightly longer. In 1950, life expectancy was just over 68 years.​

This table doesn't reflect the decline, but you can see that from 2013 US life expectancy has increased .51 years whereas Russia has increased by 1.06 years.

http://www.geoba.se/population.php?pc=world&page=2&type=015&st=rank&asde=&year=2013

Year..... US..... Russia
2013..... 78.62..... 66.66
2014..... 78.75..... 66.89
2015..... 78.88..... 67.15
2016..... 79.00..... 67.42
2017..... 79.13..... 67.72

If you additional erroneous claims you want to put out here I'll research if time permits, and refute them as well.

 

[UTChE96]

Concerning healthcare costs, you act as if insurance companies don't have incentives to reduce their pricing.

I expected you to say that at some point. I never said that insurance companies have no incentive for reducing costs. They do have incentives to reduce pricing but that's not their ultimate value driver. Increasing profits is any company's ultimate goal. The consumer by far has the strongest driver to reduce cost. In the end, the results speak for themselves. Look at Musburger's inflation chart above - the status quo has failed spectacularly because the consumer has been taken out of the equation.

 

[iatrogenic]

Did you not read my post where I provided a linked showing the cost of the operation in India ranges from $4,000 to $7,000 as opposed to your examples of $60,000 and $10,000?


This article from December reports that US life expectancy has now begun to reverse.

An American born in 2015 is expected to live 78 years and 9½ months, on average, according to preliminary data released Thursday by the Centers for Disease Control and Prevention. An American born in 2014 could expect to live about month longer, and even an American born in 2012 would have been expected to live slightly longer. In 1950, life expectancy was just over 68 years.​

This table doesn't reflect the decline, but you can see that from 2013 US life expectancy has increased .51 years whereas Russia has increased by 1.06 years.

http://www.geoba.se/population.php?pc=world&page=2&type=015&st=rank&asde=&year=2013

Year..... US..... Russia
2013..... 78.62..... 66.66
2014..... 78.75..... 66.89
2015..... 78.88..... 67.15
2016..... 79.00..... 67.42
2017..... 79.13..... 67.72

If you additional erroneous claims you want to put out here I'll research if time permits, and refute them as well.

Start by refuting my existing posts. I said the cost of the surgery was under $10,000, not $10,000. You were able to find one article that showed US life expectancy would decrease by a month 78 years from now. I can show you predictions that Hillary has a 98% chance of defeating Trump in the Presidential election two days before the vote, but it doesn't make it accurate.

Here is a direct comparison between the US and that backward country country you call home:
http://www.worldlifeexpectancy.com/world-health-review/russia-vs-united-states

Your own facts don't support your own argument. I can link multiple articles showing the U.S. life expectancy will be 100 years in the not too distant future, and the trend toward a longer life in the US is much stronger than in turdistan.

 

[iatrogenic]

I expected you to say that at some point. I never said that insurance companies have no incentive for reducing costs. They do have incentives to reduce pricing but that's not their ultimate value driver. Increasing profits is any company's ultimate goal. The consumer by far has the strongest driver to reduce cost. In the end, the results speak for themselves. Look at Musburger's inflation chart above - the status quo has failed spectacularly because the consumer has been taken out of the equation.

Nothing is stopping the consumer from putting himself in the equation. Just don't take health insurance benefits from your employer, then negotiate your own pricing with providers and pay for your own health care. Good luck.

 

[Musburger1]

Nothing is stopping the consumer from putting himself in the equation. Just don't take health insurance benefits from your employer, then negotiate your own pricing with providers and pay for your own health care. Good luck.

Let me put the numbers in context for you since you obviously can't seem to do that for yourself.

Graphs and charts are all about TRENDS. Taking the charts FROM THE LINK YOU PROVIDED, let's first look at Russia and then the US and see if we can spot trends.

In 1990, roughly the time the USSR imploded, the life expectancy for Russia was 68.9. By 2000 it had dropped to 65.3. This was the period where "Western Democracy" had been introduced to Russia and was presided over by Yeltsin and a bunch of corrupt oligarchs. Unemployment skyrocketed, suicide, drug usage, prostitution, and alcoholism skyrocketed. Putin then took over and began "draining the swamp," an ongoing process that is far from complete but heading in a positive direction. As the chart shows, by 2010 the life expectancy had increased to 68.4 and by 2015 it was 70.5.

In 1990, the US life expectancy was 75.2. The US was fairly prosperous in the 90s and by 2000 the expectancy had risen to 77.0. By 2010 the lifespan expectancy was up to 78.7 and by 2015 79.3. And now, as of December 2016 data shows the gains are reversing.

But Russia's life expectancy is still gaining whereas the US lifespan appears to have reached its apex for now.

The reasons for Russia's improvement is simply they were rising from the ashes and haven't regressed since Putin took over. In the US, the most prosperous Americans are still living longer, but a larger and larger percent of the population are getting fatter, exercising less, and addicted to opiates and other drugs. As a result maladies such as diabetes and heart disease are on the uptick and life expectancy has started to reverse.

I know you'll deny all of this because you can't even interpret charts and graphs, but what the heck. I tried.

 

[UTChE96]

Nothing is stopping the consumer from putting himself in the equation. Just don't take health insurance benefits from your employer, then negotiate your own pricing with providers and pay for your own health care. Good luck.

You seem preoccupied with negotiating leverage. My original point was that when a 3rd party pays (insurance company) it encourages overuse and artificially increases demand for medical services. Common sense dictates that when consumers have to pay for the full cost of routine services they will use fewer services. Insurance should be for catastrophic occurrences not routine care.

The ironic thing is that more and more companies (mine included) have already started transitioning to a high deductible insurance plans as a way to reduce costs. I believe over the next 10 years it will become standard as costs have skyrocketed at unsustainable rates.

 

[iatrogenic]

You seem preoccupied with negotiating leverage. My original point was that when a 3rd party pays (insurance company) it encourages overuse and artificially increases demand for medical services. Common sense dictates that when consumers have to pay for the full cost of routine services they will use fewer services. Insurance should be for catastrophic occurrences not routine care.

The ironic thing is that more and more companies (mine included) have already started transitioning to a high deductible insurance plans as a way to reduce costs. I believe over the next 10 years it will become standard as costs have skyrocketed at unsustainable rates.

We probably agree on 90% of the problem, and on possible solutions. Leverage is necessary to negotiate better pricing. Insurance companies rightfully get criticized for many things, but negotiating prices should not be included. Just think of the time you would have to spend as an individual trying to get better pricing from providers. First, you're not going to be negotiating when you have broken bones, torn tissue, or failing organs. Therefore, you will have to negotiate in advance. In fact, all of us will have to negotiate pricing in advance. That means you will need to target the hospitals, clinics, and PT facilities with which you want to trade. You will also need to talk to anesthesiologists, radiology facilities, specialists, and labs. Before you try to set meetings with these individuals, you will need to know the value that is associated with each service. For example, what is the value to you of receiving life saving emergency treatment by the ER doc on staff at the time you are dying? Once you determine the pricing for a couple of thousand possible medical procedures, you're going to need to convince the individuals to meet with you. If you are lucky, and you're not, a couple of them may meet with you in a month or two, or after they meet with 100,000 or so other individuals. Then you tell them that you will only pay "x" amount for each particular service, and then they say "sure buddy, whatever you want" right? Then you sign a contract that specifically outlines your agreed upon payment for each service, and off you go with a better health care plan in hand.

 

[iatrogenic]

Let me put the numbers in context for you since you obviously can't seem to do that for yourself.

Graphs and charts are all about TRENDS. Taking the charts FROM THE LINK YOU PROVIDED, let's first look at Russia and then the US and see if we can spot trends.

In 1990, roughly the time the USSR imploded, the life expectancy for Russia was 68.9. By 2000 it had dropped to 65.3. This was the period where "Western Democracy" had been introduced to Russia and was presided over by Yeltsin and a bunch of corrupt oligarchs. Unemployment skyrocketed, suicide, drug usage, prostitution, and alcoholism skyrocketed. Putin then took over and began "draining the swamp," an ongoing process that is far from complete but heading in a positive direction. As the chart shows, by 2010 the life expectancy had increased to 68.4 and by 2015 it was 70.5.

In 1990, the US life expectancy was 75.2. The US was fairly prosperous in the 90s and by 2000 the expectancy had risen to 77.0. By 2010 the lifespan expectancy was up to 78.7 and by 2015 79.3. And now, as of December 2016 data shows the gains are reversing.

But Russia's life expectancy is still gaining whereas the US lifespan appears to have reached its apex for now.

The reasons for Russia's improvement is simply they were rising from the ashes and haven't regressed since Putin took over. In the US, the most prosperous Americans are still living longer, but a larger and larger percent of the population are getting fatter, exercising less, and addicted to opiates and other drugs. As a result maladies such as diabetes and heart disease are on the uptick and life expectancy has started to reverse.

I know you'll deny all of this because you can't even interpret charts and graphs, but what the heck. I tried.

Hell, you actually convinced me. It is so obvious that I am embarrassed that I couldn't see it before. Living in Russia IS better than living in the U.S. Thanks for the valuable tip.

 

[Musburger1]

Interesting discussion. If you are time constrained, begin around 14:30.

 

[Musburger1]

http://www.wfaa.com/news/healthcare-to-triple-in-cost-for-retired-texas-teachers-1/426035338

Some retired Texas teachers about to get screwed.

 

[Sangre Naranjada]

I found this opinion piece interesting.

Is health care a right in America?

In a word, no. Rights are either natural immunities — existing in areas of human behavior that, because of our nature, must be free from government regulation, such as life, liberty and the pursuit of happiness, as well as speech, the press, religion, travel, self-defense and what remains of privacy — or legal claims that we qualify or bargain for, such as the right to vote, which the Constitution presumes, and the right to use your property to the exclusion of all others and the right to purchase a good that you can afford.
_________________________________________

I tend to agree with the premise here. Access to health insurance is not a right. Access to basic medical care also is not a right, though any reasonably advanced society will find a way to provide it. When we get the federal government out of the business of inventing and funding "rights" that do not exist, we might just begin to reign in the out of control spending that, if not checked, is going to be our country's ruin.

 

[Brad Austin]

No desire to start or locate an abortion thread but since it involves healthcare...

Senate votes (51-50, Pence tiebreaker) to give states right to withhold funding from Planned Parenthood

 

[Crockett]

The ironic thing is that more and more companies (mine included) have already started transitioning to a high deductible insurance plans as a way to reduce costs. I believe over the next 10 years it will become standard as costs have skyrocketed at unsustainable rates.

In a good year, I pay all my health care costs out of a health savings account. I ask for prices up front, but medical practitioners aren't used to this so sometimes I go forward with no idea what a test or procedure will cost. To be honest, once I've reached the deductible, I'll say "yes" to therapy, tests and procedures that I would have said "no" to prior to reaching my deductible. I don't feel I'm too different from the ordinary health care consumer.

 

[iatrogenic]

In a good year, I pay all my health care costs out of a health savings account. I ask for prices up front, but medical practitioners aren't used to this so sometimes I go forward with no idea what a test or procedure will cost. To be honest, once I've reached the deductible, I'll say "yes" to therapy, tests and procedures that I would have said "no" to prior to reaching my deductible. I don't feel I'm too different from the ordinary health care consumer.

But your insurance company may say no to those same tests, therapy and procedures. Even though you don't shop or negotiate those prices, I can assure you the insurance carrier does because they want to grow their profit. Losing business to a competing insurance company due to pricing differences doesn't increase their profit.

 

[nashhorn]

In a good year, I pay all my health care costs out of a health savings account.

This, the HSA, is something that I do not understand why it has not universal support.

 

[UTChE96]

To be honest, once I've reached the deductible, I'll say "yes" to therapy, tests and procedures that I would have said "no" to prior to reaching my deductible. I don't feel I'm too different from the ordinary health care consumer.

You are definitely not different from the ordinary health care consumer. Once the deductible is met, the consumer becomes insulated from the cost of service which encourages overuse.

It's a phenomenon that occurs in any shared cost group. A more trivial example is when you go out to eat with a large group that splits the bill evenly. Several folks will start to order appetizers and desserts that they would not have ordered if they were paying for only their food. They become insulated from the cost of their overuse because they get to share the cost with the group.

 

[Joe Fan]

Rattlesnake bite
No insurance
California

 

[Sangre Naranjada]

Rattlesnake antivenom costs $80K? I think I see a business opportunity!

 

[Joe Fan]

Rattlesnake antivenom costs $80K? I think I see a business opportunity!

Like the old toothbrush salesman with a streetcart offering free chips and dip?

"That tastes like shyte!"
"It is shyte. Wanna buy a toothbrush?"

 

[BrntOrngStmpeDe]

venom may be unique but it really does mostly boil down to pills/pharmacy. Going by memory a bit here, but I think I heard that 5% of patients are 50% of the costs in Medicare. Another graph I've seen shows that pills/medication is roughly 6 times the cost of other procedure aspects of medical expense.

So really its old people taking thousands and thousand of dollars of medication so a 75 year old can become a 77 year old.

Personally I think that is the part that needs to change. Insurance is viewed more like a "coupon" for much of America. They want to somehow magically consume more than they have contributed. Health insurance should be regarded like other insurance. It should be there for UNEXPECTED care, not recurring anticipated expenses. If we took recurring medication out of the health plan, I bet the ship would right itself.

Many people obviously wouldn't be able to buy the latest and greatest in the highly marketed medication world but this would likely cause the pharmaceutical companies to drop the price, or doctors would find suitable generic and/or older drugs to treat with.

 

[Phil Elliott]

A big issue that has been driving costs upward since forever is the "must care" rule, or whatever it's called, where, if I show up at an emergency room with, let's say, a knife wound to the abdomen, and no insurance/no way to pay, they must still treat me. Hospitals then have to cover that cost by jacking up the price for those who can pay.

One of the selling points of Obamacare was that if we insure everyone, then costs will go down because the above scenario won't happen. The problem is that the kinds of people who get knife wounds do not usually take care of themselves in general. So when they do come to the hospital with pneumonia, they are in pretty bad shape and the cost of care is much higher than if they had seen their regular doctor 2 weeks earlier when they had a low-grade fever. It's like someone who doesn't change the oil in their car - eventually a big repair bill is coming.

In our current scenario, as in so many cases where the government is involved, the responsible people who keep their oil changed, so to speak, are made to pay for the irresponsible people who skip it.

We need to put responsibility back on those folks who are not doing what they should and stop putting it on the backs of folks who do the right thing and pay their bills.

 

[Crockett]

Depends on what you mean by "work". Health providers probably do not mind insurance companies at all. A middle man allows them to continue negotiating higher prices and profit margins since all insurance companies do is pass the cost on to the consumer in the form of higher premiums. My goal is to reduce the escalating costs in the health care industry. The best way to do that is to have the consumer pay for most services out of pocket.

My physician friends tell me there is often more work involved in getting insurance companies to fairly compensate them for services than providing the service. Hassles out the wazoo.

 

[UTChE96]

My physician friends tell me there is often more work involved in getting insurance companies to fairly compensate them for services than providing the service. Hassles out the wazoo.

If they think that's difficult then they should try getting the average consumer to pay their ridiculous prices out of pocket. That's exactly why I want to transition to high deductible insurance plans. It will reduce demand and therefore cost.

 

[Mr. Deez]

Most doctors have a love-hate relationship with the insurance industry. They love the insurance industry's ability to pay and therefore the ability to charge more. Obviously without insurance, doctors wouldn't be able to charge anywhere near as much. However, they hate the insurance industry screwing them around on their bill and effectively interfering with their course of treatment.

I also think the type of doctor makes a difference. If you're a family doctor, you probably see less benefit to health insurance, because many people could afford to pay your bill if they had to. However, if you're a surgeon, the insurance industry is your bread and butter. Virtually nobody could afford to pay your bills without insurance.

Some are sick of the whole equation. Back in 2010, I deposed an orthopedic surgeon who was retained by a liability insurer to take a crap on my client's injuries and say her own doctor screwed up by performing shoulder surgery on her. During a break, I asked him what he thought of Obamacare, which had just passed. He said he didn't think it would do much good and favors single payer. I asked why. He said he knows reimbursements would go down, but he said he'd be willing to accept that for prompt, predictable, and reliable payment.

 

[Crockett]

Rattlesnake bite
No insurance
California

Dadgum. I have a friend who was out cycling and woke up as paramedics were putting on a neck brace. He told me that had he been conscious, he would have refused treatment and saved a $50K ambulance ride.

 

[Crockett]

If they think that's difficult then they should try getting the average consumer to pay their ridiculous prices out of pocket.

If you negotiate up front a lot of them a lot of doctors will cheerfully take less in immediate payment, I have a great ENT guy who calculates prices and bills insurance before I leave his office. He told me I needed tubes in my ears. I asked for a follow up and he said, "I can do it right now." I went in miserable. I left in less pain and the procedure wasn't much more than the "follow ups" other doctors use that waste my time and money. He was whole because I paid the copay and deductible before I left the office.

I love my family physician for different reasons. With her office, they don't know the charges for a month.

 

[UTChE96]

If you negotiate up front a lot of them a lot of doctors will cheerfully take less in immediate payment, I have a great ENT guy who calculates prices and bills insurance before I leave his office. He told me I needed tubes in my ears. I asked for a follow up and he said, "I can do it right now." I went in miserable. I left in less pain and the procedure wasn't much more than the "follow ups" other doctors use that waste my time and money. He was whole because I paid the copay and deductible before I left the office.

What you described is exactly how it should work. But folks with insurance plans never ask about the cost up front. Why should they? They just fork over a copay. If you required customers to pay out of pocket at least up to a point (high deductible) then many would decide against having unnecessary services or negotiate a better price.