Healthcare: Breakin' Down the Premiums in Consumerville

[BK]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

Good point - Insurance and too many lawsuits - brought us to where we are. I guess it's easy to blame the doctors you meet in the hospital instead of the nameless bureaucrats behind the legal system and hospital policies.

[DSpencer]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

Unless you can somehow show that the 'technology' and the 'spending' are all towards quality of life, that above statement is completely meaningless.

Equally, pain shortens lifespan.

Try again.

You claim that there's zero evidence that Americans get better care/higher tech care because they don't live longer. I'm pointing out that this implies the only metric that can measure quality of care is length of life. How this in any way requires me to prove that ALL the technology and spending are towards quality of life is a total mystery.

Your response is confusing...do you disagree and believe that length of life should be the only metric used to determine the quality of healthcare?

Another false assumption is that better care always equals better outcomes. This ignores critical factors such as the initial health of the population. Unless you blame the healthcare system for problems like obesity (which is a stretch) then certainly these factors must be considered.

So I think ignoring all other factors than life expectancy is a flawed method for determining the quality of healthcare.

And yes pain can shorten lifespan so I concede it might not be 100% actuarially worthless by your standard. However, I think it's fair to say that the primary goal is quality of life and not life extension.

I should also make it clear that I didn't claim Americans do get better care. I just think that the arguments to the contrary should use sound logic.

[c1ue]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

You claim that there's zero evidence that Americans get better care/higher tech care because they don't live longer. I'm pointing out that this implies the only metric that can measure quality of care is length of life.

It should be very easy for you to demonstrate with some facts whether or not US health care spending is so expensive because of some factor or another.

Merely asserting a possible rationale with zero substantiation is ridiculous. Somehow other nations don't engage in pain mitigation? Other nations' health care systems don't care about quality of care? Germans, British, Australians, and what not are all limping around because their substandard systems only care about how long they live?

I think not.

The links above by Reinhart clearly show that one major reason for the difference has nothing to do whatsoever with care, but rather health care administration. Or in other words, red tape of the private variety.

Your comments on obesity, or quality of care, or whatever all bounce off the facts of that like mosquitos off a windshield.

Another false assumption is that better care always equals better outcomes. This ignores critical factors such as the initial health of the population. Unless you blame the healthcare system for problems like obesity (which is a stretch) then certainly these factors must be considered.

Once again, unless you can show something which is substantive, the excuses are without merit.

For one thing, other nations smoke a lot more. Why should fat Americans be in any way worse off than chain smoking Frenchmen and Japanese?

I should also make it clear that I didn't claim Americans do get better care. I just think that the arguments to the contrary should use sound logic.

Unfortunately this isn't a question of logic. It is a question of health care results and measurement.

So far all you've done is try to throw up arguments without data.

As such, logic cannot be employed since logically the way to derail an existing set of facts is to present other facts - which either disprove the first set or demonstrate some aspect to the situation not covered by the first set.

[DSpencer]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

c1ue,

I'm tired of saying the same thing only to have you create a straw man argument to attack. I've made a very simple claim: that your reasoning is flawed. Despite stating explicitly that my claim was NOT that your conclusion was wrong, you continually pretend that is my assertion and beat that straw man with all your might.

Why should fat Americans be in any way worse off than chain smoking Frenchmen and Japanese?

According to your "logic", it doesn't matter anyway! One reason why they might be worse off is: because smoking and obesity are completely different problems with different (although overlapping) health risks and there's no reason to assume the effects would cancel exactly. A better question to ask is: Are they actually worse off?

Since I think the goal is to actually determine as much of the truth as we can...






http://www.rand.org/pubs/research_br...49/index1.html

Researchers from the Mayo Clinic found that people who are obese have an extra $1,850 in health costs, on average, a year compared with normal weight people. People who smoke, on the other hand, have $1,275 extra, on average, in health costs per year.

And for people who are morbidly obese, the costs are even higher, up to $5,500 a year.

http://www.huffingtonpost.com/2012/0...n_1408301.html

So just to reiterate one final time: I'm not saying these effects necessarily outweigh the other causes of the disparity in spending vs outcomes. I'm just saying I think that being reasonable requires giving them some thought and investigation. I work in healthcare, I need absolutely no convincing that the insurance administration costs are insanity. Our system is broken, I just don't believe that going to a socialized system is our best or only option.

[cbr]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

Current situation is so absurd it defies belief. Give me my tax lifetime tax dollars stolen to pay for all this leach system and let me buy my health services. I suppose health insurance could rationally exist for extreme, life threatening and expensive emergencies, but that is it. But one issue that cracks me up is your 4. What an insurance industry scam. Today in most states, medical malpractice is not even a viable cause of action anymore. Your insurance bought legislatures have almost cOmpletely eliminated the juries' ability to compensate victims or punish even grossly negligent health care acts. Of course premiums for medmal have not gone down. Funny, insurers have some of the highest margins around. Imagine that.

[jk]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

Today in most states, medical malpractice is not even a viable cause of action anymore. Your insurance bought legislatures have almost cOmpletely eliminated the juries' ability to compensate victims or punish even grossly negligent health care acts.

data to support this assertion?

i have to attend an annual meeting of the medical staff of the hospital at which i am on staff. the meeting is devoted to a report on medmal at the hospital in particular, at the statewide level, and nationally, including actual - wait for it - NUMBERS! and furthermore, actual specific CASES! WHICH ACTUALLY WENT TO COURT OR SETTLED! what i hear doesn't comport with your raw assertion.

[c1ue]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

I'm tired of saying the same thing only to have you create a straw man argument to attack. I've made a very simple claim: that your reasoning is flawed. Despite stating explicitly that my claim was NOT that your conclusion was wrong, you continually pretend that is my assertion and beat that straw man with all your might.

You commented that life expectancy is not the end-all, be-all of measurement of health care.

I have never stated that it is, but you then asserted a range of other rationales including obesity and quality of life without any actual evidence to back it up. I then asked you to provide this information - noting that for every positive excuse for American health care costs, there are negative ones.

According to your "logic", it doesn't matter anyway! One reason why they might be worse off is: because smoking and obesity are completely different problems with different (although overlapping) health risks and there's no reason to assume the effects would cancel exactly.

Where did I say these would cancel? The point was very straightforward: you put forward a couple of positive excuses, but I put forward an equally widespread negative excuse. Without data, all of them are useless.

You then provided data which shows what exactly? The cost of care for an obese person is somewhat more than for a smoker?

26% of Americans are obese, 32% of French smoke. Looks like a complete wash to me.

So just to reiterate one final time: I'm not saying these effects necessarily outweigh the other causes of the disparity in spending vs outcomes. I'm just saying I think that being reasonable requires giving them some thought and investigation.

Nothing wrong with that.

I work in healthcare, I need absolutely no convincing that the insurance administration costs are insanity. Our system is broken, I just don't believe that going to a socialized system is our best or only option.

So in other words, you agree that administration costs are a major source of the problem with health care in America? Which was what Reinhart was saying?

I will further go out on a limb and state that administration costs are largely independent of health and health care delivery at a national level.

As for socialized system or not - I don't see what ideology has to do with it. Do you consider public utilities socialism? Defense? Law enforcement? In other areas you have, but frankly why does it matter if something works?

If it makes your libertarian sensibilities feel better, let's call it the Homeland Health Security Initiative.

From a purely pragmatic perspective, Homeland Health Security works great in a myriad other nations, whereas the present system of private health insurance and private care works poorly both in terms of cost and reach.

Why exactly do we need to experiment, outside of fears of the demonic socialists/socialism?

[jk]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

i'm curious if anyone still following this thread is bothering to read any posts by c1ue or dspencer. i know i'm not.

[cjppjc]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

i'm curious if anyone still following this thread is bothering to read any posts by c1ue or dspencer. i know i'm not.

To be honest, when I see these arguements with all the multi quotes, I just skip past them.

[Ellen Z]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

start with this:

http://economix.blogs.nytimes.com/20...o-much-part-i/

both by uwe reinhart, health economist at princeton

+1

[thriftyandboringinohio]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

data to support this assertion?

i have to attend an annual meeting of the medical staff of the hospital at which i am on staff. the meeting is devoted to a report on medmal at the hospital in particular, at the statewide level, and nationally, including actual - wait for it - NUMBERS! and furthermore, actual specific CASES! WHICH ACTUALLY WENT TO COURT OR SETTLED! what i hear doesn't comport with your raw assertion.

Thanks, jk. Here in Ohio we've passed laws to limit these claims. Non-economic damages are capped at $250,000.00 or three times the plaintiff's economic loss, not to exceed $350,000.00 per plaintiff or $500,000.00 per occurrence.
I've seen much serious writing saying that claims paid per capita are not increasing dramatically over the past 10 years

I'd love to hear your informed view from the inside on these things.
Are the claims continuing to snowball, and are the amounts paid out still giant despite limits?

[c1ue]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

i'm curious if anyone still following this thread is bothering to read any posts by c1ue or dspencer. i know i'm not.

I'm happy you feel the need to post this.

For my part, I actually was given access to some detailed information from DSpencer.

For that matter, I'm curious why you did not put out some generalized information from your staff meeting. Certainly you cannot report too much due to fiduciary responsibility, but even ball park figures would inform.

[jk]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

Thanks, jk. Here in Ohio we've passed laws to limit these claims. Non-economic damages are capped at $250,000.00 or three times the plaintiff's economic loss, not to exceed $350,000.00 per plaintiff or $500,000.00 per occurrence.
I've seen much serious writing saying that claims paid per capita are not increasing dramatically over the past 10 years

I'd love to hear your informed view from the inside on these things.
Are the claims continuing to snowball, and are the amounts paid out still giant despite limits?

i don't have notes from the meeting last fall. my recollections: numbers are just going higher is what i hear, at least in cases that go to court. those cases, of course, set the context for settling the cases that don't go to court. numbers in the millions are no longer uncommon. further, something new which will further increase the practice of defensive medicine, is that plaintiffs are now starting to go after the personal assets of docs, not settling for the top amount covered by their insurance.

[DSpencer]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

Thanks, jk. Here in Ohio we've passed laws to limit these claims. Non-economic damages are capped at $250,000.00 or three times the plaintiff's economic loss, not to exceed $350,000.00 per plaintiff or $500,000.00 per occurrence.
I've seen much serious writing saying that claims paid per capita are not increasing dramatically over the past 10 years

I'd love to hear your informed view from the inside on these things.
Are the claims continuing to snowball, and are the amounts paid out still giant despite limits?

Some important points:

Non-economic damages are capped at the GREATER of 250k or 3x economic loss.

The per plaintiff aspect is key because any claim where: the plaintiff is a minor, the plaintiff is parent of a minor, or the plaintiff has a spouse means that loss of consortium damages will be thrown in effectively doubling the total. I don't know the numbers but would guess that the majority of plaintiffs fit this definition. So most claims can probably muster up somewhere around 500k-1M in non-economic alone. That's big time money.

There's no limit on economic damages.

The name of the game is settling cases anyway. It costs tens of thousands to defend these cases and you don't get your money back even if you win. They also can take several weeks which is a lot of opportunity cost. And what physician likes spending a decade of their life in difficult training to help people only to be put on trial and have some lawyer tell everyone that they're basically incompetent and/or don't care about their patients? So physicians don't want to end up in court even though they actually win most of the time if it's taken to that level. That's partly due to selection bias because high risk cases (for the defense) settle ahead of time. Also some insurance policies allow the ins. co. to settle the case even if the physician wants a chance to defend in trial.

My main complaint is probably just the standard for "negligence". Most doctors are very competent and care deeply about their patients. Lebron James is the best basketball player in the world and makes MUCH more money than most doctors. If he misses a last second wide-open dunk and his team loses by 1 point, should he be sued for negligence by his team? What about the emotional distress of his fans?

Given that most cases don't make it to trial and most settlements are confidential: Does accurate data even exist? Maybe the courts aggregate settlement data somehow? I have no idea.

[jk]

Re: Healthcare: Breakin' Down the Premiums in Consumerville

I'm happy you feel the need to post this.

For my part, I actually was given access to some detailed information from DSpencer.

i'm suggesting that for such discourse you don't hijack the thread, but communicate via pm. glad you learned something from the exchange, but you could have done that via pm.

on the whole, i really appreciate your posts and think you contribute significantly to the discussions here. otoh, i've noticed that occasionally you get caught caught up in these debates which quickly lose interest for me, and i suspect others.