Healthcare/Health Insurance: what is the actual problem?

Air ambulances are notoriously bad, but obviously an extreme emergency vehicle with huge costs.

Yes hospitals need Medicare volume - the oldest population is the sickest - but they don't solely survive on it and they don't go out of business due to uninsured. The shift of more and more government insured has caused increased costs to cover volume and much less average reimbursement.
 
Seattle Husker said:
Healthcare is 1/5th of our economy from what I've read. I'm not sure anyone would ever advocate removing all the profit motive. That would never get passed to the influence of the various lobbying orgs. With that said, if we have any intention of controlling or even reducing costs someone is either going to have to be removed entirely from the food chain or at least take a haircut. The US spends more $GDP per individual on healthcare than any other country by a wide margin. Simultaneously complaining about the cost of healthcare while ensuring all the existing players continue to get their cut doesn't make any sense to me.

Personally, I think the opportunity is to remove the insurance providers but drives us to socialize medicine.
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I don't know precisely where the break point would be, but I think we could tolerate a little slower "innovation" from the pharmaceutical companies if it helped keep cost down. We need to take away some of the incentive to create fabulous new drugs and market the heck out them.

I think the insurance companies should also feel a little more of the pain as well.

The doctors and the hospitals are where we need to keep spending the money, not the pharmacy and the insurance providers. If you've got to make a choice about changing the dynamics of the healthcare market and therefore "picking winners and losers" then the choice really isn't that hard.
 
theiioftx said:
Air ambulances are notoriously bad, but obviously an extreme emergency vehicle with huge costs.

Yes hospitals need Medicare volume - the oldest population is the sickest - but they don't solely survive on it and they don't go out of business due to uninsured. The shift of more and more government insured has caused increased costs to cover volume and much less average reimbursement.
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There's still no place to charge a patient $48,000 when you're taking $6,500 eagerly.

Hospitals, almost by definition, survive on Medicare's cost based reimbursement. If it costs you $12.45 million to operate in FY 2016 and you only brought in 12.00 million, CMS will adjust your rate accordingly and cut you a check. The money you make off of other payers will provide you with your margin. It would be like your basic budget (surviving) being mortgage, insurance, utilities, food expenses, car expenses, etc. You'd pay for that out of your "medicare" reimbursement. You pay for your UT season tickets, your trip to Cancun, your new 65" flat screen and your trip to Dallas in October out of your BC/BS reimbursement.
 
Yes, it's written by Ezra Klein's who's the stereotypical smug liberal, but this article explains the GOP's meltdown pretty well. It also explains how all three of the top GOP leaders (Trump, Ryan, and McConnell) failed. And though it doesn't come right out and predict single payer like I do, so I can't call it a "validate Deez" article, but it sets up the politics for it well.

What's very clear to me is that while the GOP leadership has always had some healthcare reform plans in their tool shed (and some of them pretty good), they never had the confidence or ability to sell any of them even to their own membership, much less to the general public. That's why the bills offered this year haven't been free market-oriented bills but instead have essentially been half-assed versions of Obamacare, which is why I'm not sad about the beat-down in the Senate.

I think a lot of that is due to what I mentioned earlier - a large segment of the GOP voting bloc simply isn't willing to trust the free market when it comes to healthcare. They prefer government dependency. They don't like Obamacare mostly because they didn't like Obama, not because they had a substantive policy disagreement with the law. Ironically, some of them are even some of the "winners" under Obamacare (previously uninsurable or now on Medicaid, etc.).

Because a lot of these dependent voters are now an indispensable part of the GOP's coalition (which they can't afford to lose), that basically dooms any kind of free market approach. That leaves the GOP with having to go with something that still mostly preserves government guarantees but making enough changes to claim they've repealed Obamacare.

It's a mess, and this is why I still think a full-blown national healthcare system (single payer or public option (like what they have here in Germany) is on its way. It's just a matter of whether it'll be on the GOP's terms (meaning it'll give the insurance industry a "severance package" of some kind) or the Democrats' terms (funds every kind of depraved procedure to appease abortionistas and trannies).
 
Mr. Deez said:
Yes, it's written by Ezra Klein's who's the stereotypical smug liberal, but this article explains the GOP's meltdown pretty well. It also explains how all three of the top GOP leaders (Trump, Ryan, and McConnell) failed. And though it doesn't come right out and predict single payer like I do, so I can't call it a "validate Deez" article, but it sets up the politics for it well.

What's very clear to me is that while the GOP leadership has always had some healthcare reform plans in their tool shed (and some of them pretty good), they never had the confidence or ability to sell any of them even to their own membership, much less to the general public. That's why the bills offered this year haven't been free market-oriented bills but instead have essentially been half-assed versions of Obamacare, which is why I'm not sad about the beat-down in the Senate.

I think a lot of that is due to what I mentioned earlier - a large segment of the GOP voting bloc simply isn't willing to trust the free market when it comes to healthcare. They prefer government dependency. They don't like Obamacare mostly because they didn't like Obama, not because they had a substantive policy disagreement with the law. Ironically, some of them are even some of the "winners" under Obamacare (previously uninsurable or now on Medicaid, etc.).

Because a lot of these dependent voters are now an indispensable part of the GOP's coalition (which they can't afford to lose), that basically dooms any kind of free market approach. That leaves the GOP with having to go with something that still mostly preserves government guarantees but making enough changes to claim they've repealed Obamacare.

It's a mess, and this is why I still think a full-blown national healthcare system (single payer or public option (like what they have here in Germany) is on its way. It's just a matter of whether it'll be on the GOP's terms (meaning it'll give the insurance industry a "severance package" of some kind) or the Democrats' terms (funds every kind of depraved procedure to appease abortionistas and trannies).
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Better option:
- eliminate the mandates
- reduce Obamacare to high deductible or catastrophic plans subsidized by taxpayers (this includes anyone with pre-existing conditions).
- cut the Medicaid payments, but not too severely.

Basically, people who want a government-subsidized or government-paid health insurance can get one.
 
Mr. Deez said:
That sounds a lot like the public option that was in the original Obamacare proposal.
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Yeah, but I would design it such that it is medicaid-plus, and as such, no right-thinking person would want it. Basically, incentivize people to want private insurance.
 
mchammer said:
Yeah, but I would design it such that it is medicaid-plus, and as such, no right-thinking person would want it. Basically, incentivize people to want private insurance.
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Not sure that I follow. If having no insurance and facing bankruptcy court if someone in the family gets significantly sick or gets badly injured wasn't enough to induce someone to buy private insurance, then why would offering a junky Medicaid option be enough? All you're doing is giving them another option they could use to avoid buying private health insurance.

Who's not buying health insurance? Basically it's two groups. It's people who are too broke-*** poor to afford it, and it's people who perhaps could afford it but don't see it as a smart use of their money. They rarely get sick and rarely see a doctor, so they decide to rely on their immune system, try to avoid getting hurt, and pay cash or use a credit card for the rare occurrences in which they see a doctor.

Under your plan, the broke-*** poor will be on real Medicaid. If they're a little richer than that or if they're in the second group (have the money but don't want to spend it on health insurance), they'll either stay with nothing (if the public option is only a little cheaper than private health insurance) or they'll choose the public option (since it's better than nothing). More likely, the public option will be a lot cheaper if it's only covering catastrophic care and has a large deductible. Accordingly, your people who are voluntarily going without health insurance will simply buy the public option. Frankly, a high-deductible, catastrophic plan is exactly what many of them are looking for.
 
Mr. Deez said:
Not sure that I follow. If having no insurance and facing bankruptcy court if someone in the family gets significantly sick or gets badly injured wasn't enough to induce someone to buy private insurance, then why would offering a junky Medicaid option be enough? All you're doing is giving them another option they could use to avoid buying private health insurance.

Who's not buying health insurance? Basically it's two groups. It's people who are too broke-*** poor to afford it, and it's people who perhaps could afford it but don't see it as a smart use of their money. They rarely get sick and rarely see a doctor, so they decide to rely on their immune system, try to avoid getting hurt, and pay cash or use a credit card for the rare occurrences in which they see a doctor.

Under your plan, the broke-*** poor will be on real Medicaid. If they're a little richer than that or if they're in the second group (have the money but don't want to spend it on health insurance), they'll either stay with nothing (if the public option is only a little cheaper than private health insurance) or they'll choose the public option (since it's better than nothing). More likely, the public option will be a lot cheaper if it's only covering catastrophic care and has a large deductible. Accordingly, your people who are voluntarily going without health insurance will simply buy the public option. Frankly, a high-deductible, catastrophic plan is exactly what many of them are looking for.
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You got it. I should have said no person would want it if they could afford private health insurance. If not, here's government plans A & B that is a cheaper (based on your income) and would let you avoid bankruptcy.
 
There are multiple reasons why health care now makes up close to 20% of the economy and costs keep spiraling upward. Putting aside all the possible factors (collusion, lack of competition, aging demographics, etc.), one of the biggest factors is simply the deteriorating physical condition of the population.

Insurance prices are set based on the risk/cost analysis of the pool of insured. For example, if 1000 people were to be insured and it is known that half of them would contract cancer within the next 12 months, the premiums would probably need to be about $75,000 or more per year - probably even higher than that - in order for the insurance company to stay in business. So if a large percentage of the population has health problems, and everyone in the population is going to be taken care of, the costs are going to be high.

The US leads the world in obesity and is getting fatter. The incidence of diabetes is expanding to lower age groups, the incidence of cancer continues rising, and the mean age of the population is increasing. Americans in general continue to maintain a lifestyle (dietary and exercise habits) that is detrimental to their health. Until this changes, costs will continue to rise even if the fraud, collusion, etc. is reigned in somewhat.
 
mchammer said:
You got it. I should have said no person would want it if they could afford private health insurance. If not, here's government plans A & B that is a cheaper (based on your income) and would let you avoid bankruptcy.
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I just don't buy that assumption. I think people who are relatively healthy (and therefore don't have to worry as much about maxing out deductibles every year) will choose the public option, because it would save them a fortune.
 
Mr. Deez said:
I just don't buy that assumption. I think people who are relatively healthy (and therefore don't have to worry as much about maxing out deductibles every year) will choose the public option, because it would save them a fortune.
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Private also includes employer-sponsored plans where there are more doctor choices. Gov plans would be cheaper but would limit choice for cost control.
 
mchammer said:
Private also includes employer-sponsored plans where there are more doctor choices. Gov plans would be cheaper but would limit choice for cost control.
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The core problem here is that you're comparing the government option with private insurance when you should be comparing it with having nothing. Until you do something radical about the cost of private health insurance, it's not even a serious option for these people.
 
Crockett said:
Here is a look at an innovative approach to cost control and getting around the expensive, non-productive Hospital Chargemasters vs. Insurance Companies lose/lose spiral we're living in.
http://time.com/4649914/why-the-doc...l&utm_source=facebook.com&utm_campaign=buffer
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That's pretty cool. It appears from the article that exactly what you'd want and expect from a cash based, consumer decision model happened. The consumer sought out quality care at the lowest cost.

If we took away all the little tax incentives in the tax code and instead gave everyone a large tax break for saving for their own healthcare, perhaps that could be the incentive to make this model work. As big a part of the economy as healthcare has become, it makes sense to develop tax code specifically to encourage people to do the smart and fiscally responsible thing.
 
BrntOrngStmpeDe said:
That's pretty cool. It appears from the article that exactly what you'd want and expect from a cash based, consumer decision model happened. The consumer sought out quality care at the lowest cost.

If we took away all the little tax incentives in the tax code and instead gave everyone a large tax break for saving for their own healthcare, perhaps that could be the incentive to make this model work. As big a part of the economy as healthcare has become, it makes sense to develop tax code specifically to encourage people to do the smart and fiscally responsible thing.
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That model works when you know what the problem is. Like when I know my car needs it's timing belt replaced, I like seeing the all-in cost to compare mechanics. The problem is the diagnoses. How does this clinic handle "I have a pain in my side"? Is there a flat fee for that analysis (akin to hooking your car up to the diagnostics machine) or as I suspect an it depends?

I have a Health Savings Account as a seldom user of health care. This means I have a High Deductible Plan (HDP) and my company contributes $750 into a bank account each year that I can use on whatever health related costs I want. The unspent money accumulates year over year. The plan still offers me the protection of insurance but if I don't use it I can leverage that money down the road to pay major health costs should they occur. The government has a limit on the how much money can accrue in this account I believe but I like this program a lot.

This program wouldn't work for a frequent consumer of healthcare as they would be paying a lot of out of pocket expenses.
 
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Seattle Husker said:
That model works when you know what the problem is. Like when I know my car needs it's timing belt replaced, I like seeing the all-in cost to compare mechanics. The problem is the diagnoses. How does this clinic handle "I have a pain in my side"? Is there a flat fee for that analysis (akin to hooking your car up to the diagnostics machine) or as I suspect an it depends?

I have a Health Savings Account as a seldom user of health care. This means I have a High Deductible Plan (HDP) and my company contributes $750 into a bank account each year that I can use on whatever health related costs I want. The unspent money accumulates year over year. The plan still offers me the protection of insurance but if I don't use it I can leverage that money down the road to pay major health costs should they occur. The government has a limit on the how much money can accrue in this account I believe but I like this program a lot.

This program wouldn't work for a frequent consumer of healthcare as they would be paying a lot of out of pocket expenses.
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To me, a similar plan is the real answer to health insurance coverage. This provides you incentives to make good decisions and not overuse care because you are not paying for it.

In order for it to work, EVERYBODY would need to contribute. Otherwise, it would not work.
 
theiioftx said:
To me, a similar plan is the real answer to health insurance coverage. This provides you incentives to make good decisions and not overuse care because you are not paying for it.

In order for it to work, EVERYBODY would need to contribute. Otherwise, it would not work.
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Of course, it also presupposes that we are all educated enough to drive our own healthcare. I'm not sure that's a solid assumption for many healthcare consumers.
 
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Seattle Husker said:
That model works when you know what the problem is. Like when I know my car needs it's timing belt replaced, I like seeing the all-in cost to compare mechanics. The problem is the diagnoses. How does this clinic handle "I have a pain in my side"? Is there a flat fee for that analysis (akin to hooking your car up to the diagnostics machine) or as I suspect an it depends?

I have a Health Savings Account as a seldom user of health care. This means I have a High Deductible Plan (HDP) and my company contributes $750 into a bank account each year that I can use on whatever health related costs I want. The unspent money accumulates year over year. The plan still offers me the protection of insurance but if I don't use it I can leverage that money down the road to pay major health costs should they occur. The government has a limit on the how much money can accrue in this account I believe but I like this program a lot.

This program wouldn't work for a frequent consumer of healthcare as they would be paying a lot of out of pocket expenses.
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That sounds like the kind of plan we should be promoting. I think with a couple of tweaks it could be our solution. I would suggest that we take off the contribution caps or at least have them very high, and give some financial incentive to starting to contribute as early as possible and sustain it year after year. Perhaps their could be a tax credit that is tied to how long you've been in the plan and how consistently you've participated.

the frequent users who also happen to be poor are always the biggest challenge. how do you incentivize prudent and efficient utilization without an associated personal cost? perhaps their could be some sort of account matching dynamic that would still allow to participate in this model but with an low income healthcare grant. Maybe start every low income individuals HSA with $1000 and then give them a 2-for-1 credit for every dollar they contribute. This would at least give them the opportunity to see a doctor a couple times of year and if the money carries over from year to year, then perhaps they would regard it as 'theirs' and take care of it by making good decisions.

It doesn't solve the catastrophic or even the high expense disease for poor people but honestly, unless we decide to go to a single payer system, I don't know of any system that is ever going to solve that particular problem.
 
Mr. Deez said:
The core problem here is that you're comparing the government option with private insurance when you should be comparing it with having nothing. Until you do something radical about the cost of private health insurance, it's not even a serious option for these people.
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Right, if you don't have private insurance, then the choices are Obamacare (stripped down to core offerings) or nothing at all. Why is this hard to understand? A lot people actually want the latter (or Medicaid if they are poor enough). The people who want Obamacare will moan, but their coverage is subsidized so who cares what they think.
 
mchammer said:
Right, if you don't have private insurance, then the choices are Obamacare (stripped down to core offerings) or nothing at all. Why is this hard to understand? A lot people actually want the latter (or Medicaid if they are poor enough). The people who want Obamacare will moan, but their coverage is subsidized so who cares what they think.
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I understand it, and I'm not necessarily saying it's a bad idea. However, I think it's going to be a hard sell. Conservatives won't like it because in same ways, it's more liberal than Obamacare. It doesn't have the mandate and drops the regulations, but it creates a public option. Furthermore, it doesn't do anything substantial about costs. Liberals won't like it because it'll put the lower middle class and sick people into a system with poor coverage.
 
Joe Fan said:
Full video of the debate^^, if interested

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I'm a big Shapiro fan and think he's a tremendously gifted conservative thinker and commentator, so I watched this last night. I actually think he was a little off his game. He let Cenk get away with some things that he didn't have to let him get away with.
 
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Must we accept Health Care = Health Insurance?
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Heck most people don't even seem to know the difference between "care" and "insurance".

Neither Democrats nor Republicans seem to side with me. I just want to be able to make good choices mostly spending my own money, but with comfort of knowing that if I'm struck with a medical catastrophe like cancer or a broken back, I've got coverage after the first $2K.
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Exactly. One problem is that even high-deductible plans for young healthy people can still be pretty expensive. This was already true before ACA, and then after ACA the cost went up plus you got fined/taxed (which it is depends on which law is being circumnavigated) for finding it too expensive. Another problem is that so many places charge you on a big discount if you have insurance, even if you are below deductible and paying it yourself. You can find places that discount for paying out of pocket but it takes some searching.

The plan all along with Obamacare was to let it fail and then blame the free market.
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That's how most stuff works in this country. 1. Government increases intervention in system X. 2. System X gets worse. 3. People call system X a free-market and want more intervention. 4. Return to step 1.
 
Statalyzer said:
That's how most stuff works in this country. 1. Government increases intervention in system X. 2. System X gets worse. 3. People call system X a free-market and want more intervention. 4. Return to step 1.
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If more people understood this, the world would be a better place.
 
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