Good health care discussion

[LazyBoy]

I'm posting a link to a good healthcare discussion at reddit that might be informative.

It spun out of a comparison of costs for a hip replacement costs in the USA vs Spain.
There are people in the industry giving good background on costs and processes in the US system.

http://www.reddit.com/r/theydidthema..._spain/ci0m96r

(Don't bother to try to join the discussion. People move on to new discussions quickly there.)

[Polish_Silver]

Re: Good health care discussion

That does seem to be a good discussion. I'd agree that the billing system is a ridiculous overhead, but they never ask why you need "single payer" for medicine, and you don't need it for food, cars, houses. It is because almost everything "not medicine"
has transparent price discovery and competition. The need for single payer arises from the lack of price transparency and competition. I don't know that the laws are, but if all the grocery stores agreed to eliminate price labels, wouldn't the DA come down hard on them for "restraint of trade" or something?
"non profit" hospitals keep their fees and salaries secret. Meanwhile, in the highly competitive grocery business, most prices and wages are widely known.

[verdo]

Re: Good health care discussion

all ill say is that here in Canada, no one worries about the balance sheet cost of getting sick, or the quality of the care we may receive if we ever get terminally ill. I don't have the same anti government view when it comes to health care as i may with other areas, mainly because i have real life proof of how well it has worked...particularly for my bottom line

[Polish_Silver]

Re: Good health care discussion

all ill say is that here in Canada, no one worries about the balance sheet cost of getting sick, or the quality of the care we may receive if we ever get terminally ill. I don't have the same anti government view when it comes to health care as i may with other areas, mainly because i have real life proof of how well it has worked...particularly for my bottom line

A mixed private/public system works well in many places such as Hong Kong. Basic stuff should be tax paid, at least for low income people. The US problem is that all the institutions, even government run hospitals , charge a fortune. It's a cartel, not a free enterprise model of business.

[dcarrigg]

Re: Good health care discussion

Basic stuff should be tax paid, at least for low income people.

21% of Americans were on Medicaid as of 2010. It's looking like the Medicaid expansion on of the ACA will bump this number by ~8% over time. By 2016, unless there's some miracle jobs boom out of nowhere, I expect we will see about the poorest 1/3 of Americans (particularly children of single parents and the elderly) wrapped up in a taxpayer funded healthcare system. Meanwhile, the percentage of people on Medicare will rise a bit with the boom generation, maybe to 18-20% (many folks are on both).

The problem in America is the doughnut hole. No, not the Medicare part D doughnut hole. The great middle class doughnut hole. The bottom 1/3 will be covered. The wealthiest 1/3 will usually have enough capital / resources / employee benefits that, while thrown into difficult spaces and definitely feeling heavy financial pain, they can usually survive the crazy healthcare market financially (usually they have access to ~300k in capital in one way or another). The middle 1/3 - these are the people who usually have the crappier health plans and not enough networth to cover anything going wrong (usually have access to only ~100k in capital and often might have debt to match).

In a lot of ways the system is a bit weird. But people around the median do especially badly. They usually earn somewhere in the $50k/yr range as a household, either one or two earner being typical. And that often means jobs that don't come with gold-plated bennies like the $100k/yr household probably can get. Meanwhile, the $25k/yr household can get access to government healthcare.

So the breakdown now is ~15% (~46 million) of people without any form of health insurance whatsoever. They are sometimes in the bottom third that just didn't sign up. More often they are young folks or folks in the middle third who either don't get it from employers, can't afford it as small business owners, or who've lost a job and can't afford COBRA. ~21% (~67 million) people are on Medicaid. Around 61% (~193 million) had private health insurance, about half of whom have plans that aren't so great. And the remainder are on Medicare without Medicaid.

It's the ~86 million or so with barebones coverage and the ~46 million or so with no plans that are in the worst spot in this scheme. And a lot of times they're working folks in the middle. How many horror stories have there been over the years on this site alone? I think it's obvious to a huge number of Americans that there has to be a better way.

[Polish_Silver]

Middle class plight.

21% of Americans were on Medicaid as of 2010. It's looking like the Medicaid expansion on of the ACA will bump this number by ~8% over time.

The problem in America is the doughnut hole. No, not the Medicare part D doughnut hole. The great middle class doughnut hole. .

I agree that the middle class is hit very hard. No insurance system alters the fact that prices are far too high in this country. Insurance exacerbates it by hiding the cost as low salaries or general taxes. Insurance solves the social equity problem, but not the cost problem.

70% of the cost is chronic degenerative disease: diabetes, atherosclerosis, etc. The argument "you can't price shop ambulance service" doesn't apply to the vast majority of medical expenses. Even when you have time to price shop, as in obstetrics (9 months) , the prices in this country are exhorbitant.

In Taiwan, the system is called "insurance" but you are dealing directly with the government. There is no "insurance company" or "policy" other than what you have by being a citizen. They have a gate keeping system--nation id cards. If you want something that is not covered, you pay out of pocket.

[Ghent12]

Re: Middle class plight.

That reddit discussion is a bit lowbrow, as you might expect from reddit. All I read was some whining about the middle man. Does anyone actually believe in the middle man fallacy anymore? Of course the middle man adds value, but the situation with health care in the U.S. is simultaneously more complex and much easier to understand than blaming the claims department of insurance companies and similar entities (the departments which incidentally keep insurance costs lower than they otherwise would have been). Yes, there is distortion in the market of health care, but it is rooted in government policy.

Does anyone ask why the system is so ridiculous with regard to insurance company involvement? Simple Supply and Demand explain a lot of the increase in health care prices as Supply is tightly controlled and restricted in most U.S. states because of anti-human laws passed by local/state governments on behalf of big businesses (Certificate of Need specifically--"Can I please open a business to compete with your business?"), and Demand is continuing to grow as our demographics shift to a more old-heavy model which thankfully is not nearly as bad as the one China faces.

Insurance companies do provide a lot of distortion into the market because they are a third party, and just like any third party involvement, the customer and the supplier will not be fully satisfied with the "streamlining" done even though they willingly paid for the services. However, insurance companies aren't to blame for acting in the most logical way that is also lawful. Who made their services a tax-free benefit that employers could give employees, which unnaturally expanded their market? Which entities maintain fairly strict barriers to entry for insurance competition?

The market for health care is definitely distorted, but it is U.S. federal and state and local government policy for it to be that way. Get rid of CON and have Congress utilize the "commerce clause" in an actual legitimate way (knocking down state barriers on trade) and repeal the parts of the Affordable Care Act (Obamacare) which mandate insurance coverage and also the parts which restrict exchange participants (i.e. state/local pools vice national ones) and we'll have gone a very long way to arresting the price of health care. There's no need to expand the VA or Medicaid to cover all Americans (the goal of some).

[Polish_Silver]

How to blame insurance

That reddit discussion is a bit lowbrow, as you might expect from reddit. All I read was some whining about the middle man. Does anyone actually believe in the middle man fallacy anymore? Yes, there is distortion in the market of health care, but it is rooted in government policy.

Does anyone ask why the system is so ridiculous with regard to insurance company involvement? Simple Supply and Demand explain a lot of the increase in health care prices as Supply is tightly controlled and restricted in most U.S. states because of anti-human laws passed by local/state governments on behalf of big businesses (Certificate of Need specifically--"Can I please open a business to compete with your business?"), and Demand is continuing to grow as our demographics shift to a more old-heavy model which thankfully is not nearly as bad as the one China faces.

Insurance companies do provide a lot of distortion into the market because they are a third party, However, insurance companies aren't to blame for acting in the most logical way that is also lawful.

. . .).

The insurance companies have national reach, and I believe they play a large part in continuing these policies and in the shaping of Obama care. Naturally they acted in their own self interest. However, as moral agents, some of them could have been more outspoken about how bad the system is, and worked for change. It's similar to the banks. You can say it is "public policy only". But public policy has been influenced by lobbyists, campaign funding, etc. I think the insurance industry welcomes the "tax free" benefit because it expands their market.

The real question is, why do the large insurers not compel providers to lower costs the way Galbraith et al. says they should? A: collusion--no real competition.

[lektrode]

Re: How to blame insurance

The insurance companies have national reach,...
...
The real question is, why do the large insurers not compel providers to lower costs the way Galbraith et al. says they should? A: collusion--no real competition.

they may have 'national reach' but are still prevented by state regulations(?) from selling policies on a national scale ??

otherwise we'd see outfits like kaiser permanente - who IMHO offers the best model going forward - operating in all/most states, vs the handful they are in today.

and the reason why i think they/KP are the best model is simple: they are both the 'underwriter' and the provider - and, not the least of reasons: are a 'non profit' (nears i know)

also a purrrfect example of why we dont want to let 'the perfect be the enemy of the good' - since KP aint perfect, but they beat the hell out of some of the others - ie: 'insurers' that IMHO border on criminal enterprises, as we 'insured' are NOT the 'customers' - with the insurers being middlemen/skimmers acting as fronts for the big corporates that ARE the 'customer' - with the insurers basically being paid to delay/deny/obfuscate said 'coverage' and thereby profit - by their corporate customers...

just my obs/.02 - please feel free to correct/debate me here - am looking to be proven wrong on this (but i dont think anybody actually can, but DO try ;)

[Ghent12]

Re: How to blame insurance

The insurance companies have national reach, and I believe they play a large part in continuing these policies and in the shaping of Obama care. Naturally they acted in their own self interest. However, as moral agents, some of them could have been more outspoken about how bad the system is, and worked for change. It's similar to the banks. You can say it is "public policy only". But public policy has been influenced by lobbyists, campaign funding, etc. I think the insurance industry welcomes the "tax free" benefit because it expands their market.

The real question is, why do the large insurers not compel providers to lower costs the way Galbraith et al. says they should? A: collusion--no real competition.

Health insurance companies have "national reach" by virtue of them having the ability to set up shop within 50 or so separate markets. Blue Cross/Blue Shield, for example, may be available in many parts of the country, but they must provide only the coverage allowed by the laws of the individual states and localities. The health insurance market is not national--it's local and state-wide, and this is inhuman.

[Polish_Silver]

Kaiser: Achtung!

they may have 'national reach' but are still prevented by state regulations(?) from selling policies on a national scale ??

otherwise we'd see outfits like kaiser permanente - who IMHO offers the best model going forward - operating in all/most states, vs the handful they are in today.

and the reason why i think they/KP are the best model is simple: they are both the 'underwriter' and the provider - and, not the least of reasons: are a 'non profit' (nears i know)

also a purrrfect example of why we dont want to let 'the perfect be the enemy of the good' - since KP aint perfect, but they beat the hell out of some of the others - ie: 'insurers' that IMHO border on criminal enterprises, as we 'insured' are NOT the 'customers' - with the insurers being middlemen/skimmers acting as fronts for the big corporates that ARE the 'customer' - with the insurers basically being paid to delay/deny/obfuscate said 'coverage' and thereby profit - by their corporate customers...

just my obs/.02 - please feel free to correct/debate me here - am looking to be proven wrong on this (but i dont think anybody actually can, but DO try ;)

My parents used Kaiser, and over all the care seemed to be very high quality. I went with my father to one appointment. He had an horrific growth on his ear. After waiting a few minutes, we got in to the dermitologists office. He diagnosed it in 30s, cut it off in 20s and we were out of there in 2 minutes. Highly efficient.

That's a good point that they insure as well as treat. Geico does that and their auto insurance rates are very competitive. Blue Cross is available everywhere isn't it? People who have looked into it think insurance is close to being a nationwide monopoly. Lots of brand names, but very few really independent companies. I don't know details. If there was real competition, I don't think we'd be seeing the prices we do. (hospitals are as much to blame as insurers, of course!)

[aaron]

Re: How to blame insurance

Health insurance companies have "national reach" by virtue of them having the ability to set up shop within 50 or so separate markets. Blue Cross/Blue Shield, for example, may be available in many parts of the country, but they must provide only the coverage allowed by the laws of the individual states and localities. The health insurance market is not national--it's local and state-wide, and this is inhuman.

I am sure the Supreme Court said that a corporation is a person, not a moral agent.

Taiwan's system is good. Is it still affordable?

Canada's is good. The government helps out everybody at an affordable level, AND there are private insurance options you can purchase for yourself.

[Polish_Silver]

Re: How to blame insurance

I am sure the Supreme Court said that a corporation is a person, not a moral agent.

Taiwan's system is good. Is it still affordable?

Canada's is good. The government helps out everybody at an affordable level, AND there are private insurance options you can purchase for yourself.

I last used Taiwan in about 2006. I had no "insurance" so had to pay the full cost. It was what co-payments would have been in California. It is totally no-nonsense. The examination room is separated from the hallway by a plastic curtain. When a biopsy was done on my foot, there was a girl in the room typing and giggling. And after the surgery, a nurse helped me get across the street to a pharmacy. If I had any big ticket medical problem, I'd be on the first plane over there. (There may be other equally cost effective places--Mexico? Guatemala?)