New U.S. Healthcare Reform, No New Business for Insurance Co

[Grave_n_idle]

I suppose all these people are idiots? And have NO idea what they are talking about?

Possibly, I haven't read any of those books.

I have lived under both US and UK systems, though - and I know which I prefer.

[Grave_n_idle]

Leaving aside the argument about whether the current US healthcare 'system' is free market, it is definitely profit-motivated. And costs something ridiculous per head per year ($7000 rings a bell). By contrast, the more socialised models common in Europe, wich are not profit-motivated, manage to provide much better care for literally half the cost or less.

The evidence, it seems, is against running healthcare systems for profit, if one wants the full population to be covered cheaply and effectively.

What we really need on NS, is a sticky 'data' thread... so we don't have to look all this stuff up every time.

I believe the last time this debate came up, we had something like $7000 as the per capita price in the US, and about... $3700 in the UK.

[Surote]

Medicare and Medicaid are special mechanisms added to the free market model. They don't replace it - they PAY it

People excuse lower class people get ripped off though healthcare is just that health not a profit if we can lower the expense on the plan or increase the revenue I support it.

[Grave_n_idle]

Medicare and Medicaid are special mechanisms added to the free market model. They don't replace it - they PAY it

People excuse lower class people get ripped off though healthcare is just that health not a profit if we can lower the expense on the plan or increase the revenue then I support it thourgh

If i'm understanding what you're saying - I agree.

Ideally, we would find some way to control prices, rather than just stepping in to cover whatever the current model says healthcare is worth. I'm not necessarily talking about capping prices - more like, making the price correspond in some way to the treatment.

[Muravyets]

If i'm understanding what you're saying - I agree.

Ideally, we would find some way to control prices, rather than just stepping in to cover whatever the current model says healthcare is worth. I'm not necessarily talking about capping prices - more like, making the price correspond in some way to the treatment.

That would be another argument in favor of a national plan. Even if it is not a "proper" NHS such as in other countries, a national single payor plan would be big enough to command far, far better bargaining power than individual employers, or individual consumers, ever could. The size of such a group client alone could be enough to control prices, as there would be no hardship to insurers to lower their rates to be competitive, when they are going to get so many premiums being paid for their trouble.

[You-Gi-Owe]

The thing is, what is being pushed not is not really health care reform, it's healthcare insurance reform. The method that the Democratic Party government seeks is to control the purse strings of health care and the populace, not to really make it any more affordable.

If they really wanted to make health care more affordable, they'd take a look at the doctors' and hospitals' expenses. The doctors are being sucked dry by the malpractice insurance rates that they are forced to pay because of unscrupulous (not all) ambulance chasing lawyers. Former Presidential candidate John Edwards was such a crook. Did you know that in a court sumation he "channeled" the spirit of a living girl from the time when she was in the womb?

http://www.pittsburghlive.com/x/pittsburghtrib/s_202515.html

If you really want health care reform, then you need tort reform. The doctor's fees can then become lower. They won't need to schedule costly batteries of tests to cover their asses, either.

[Eofaerwic]

If i'm understanding what you're saying - I agree.

Ideally, we would find some way to control prices, rather than just stepping in to cover whatever the current model says healthcare is worth. I'm not necessarily talking about capping prices - more like, making the price correspond in some way to the treatment.

That would be another argument in favor of a national plan. Even if it is not a "proper" NHS such as in other countries, a national single payor plan would be big enough to command far, far better bargaining power than individual employers, or individual consumers, ever could. The size of such a group client alone could be enough to control prices, as there would be no hardship to insurers to lower their rates to be competitive, when they are going to get so many premiums being paid for their trouble.

The UK NHS model is actually relatively rare in European social medicine. France and Belgium for example use an insurance based model for example where the services are provided by private (often non-profit) hospitals and doctors but the insurance is public. That may be a more effective model for the US than the UK NHS. Having experienced both types, the UK NHS is cheaper on the public, free at point of contact but somewhat slower and with a bit less choice, the Belgian system is slightly more expensive for people as there is often co-pays and it works on reimbursment system (being insurance) but is quicker in terms of treatment. It's important to note that you never hear in the public insurance system of payments being refused and premiums are income related not 'risk' related.

[North Suran]

The UK NHS model is actually relatively rare in European social medicine. France and Belgium for example use an insurance based model for example where the services are provided by private (often non-profit) hospitals and doctors but the insurance is public. That may be a more effective model for the US than the UK NHS. Having experienced both types, the former is cheaper on the public, free at point of contact but somewhat slower and with a bit less choice, the latter is slightly more expensive for people as there is often co-pays and it works on reimbursment system (being insurance) but is quicker in terms of treatment. It's important to note that you never hear in the public insurance system of payments being refused and premiums are income related not 'risk' related.

I think you got the "former" and "latter" mixed up.

[Eofaerwic]

I think you got the "former" and "latter" mixed up.

Not exactly but it was very confusing so I've fixed it.

[Sibirsky]

Leaving aside the argument about whether the current US healthcare 'system' is free market, it is definitely profit-motivated. And costs something ridiculous per head per year ($7000 rings a bell). By contrast, the more socialised models common in Europe, wich are not profit-motivated, manage to provide much better care for literally half the cost or less.

The evidence, it seems, is against running healthcare systems for profit, if one wants the full population to be covered cheaply and effectively.

They do not provide better care. Provide to more people? (As % of total) Yes, everyone has coverage. Better care to those that have it? Absolutely not. When is the last time you have heard of an American going abroad for a medical procedure for any reason other than to save money? The Brits (with money obviously) come here all the time.

[Gift-of-god]

Leaving aside the argument about whether the current US healthcare 'system' is free market, it is definitely profit-motivated. And costs something ridiculous per head per year ($7000 rings a bell). By contrast, the more socialised models common in Europe, wich are not profit-motivated, manage to provide much better care for literally half the cost or less.

The evidence, it seems, is against running healthcare systems for profit, if one wants the full population to be covered cheaply and effectively.

They do not provide better care. Provide to more people? (As % of total) Yes, everyone has coverage. Better care to those that have it? Absolutely not. When is the last time you have heard of an American going abroad for a medical procedure for any reason other than to save money? The Brits (with money obviously) come here all the time.

Not quite. The US system has two very different levels of quality. They have very good quality for one class of citizen (i.e those who can afford it), and another much poorer one for everyone else (those who cannot). The average of these two is worse than the average of any other developed nation, as we can glean from things like infant mortality rates and life expectancy.

[Treznor]

Leaving aside the argument about whether the current US healthcare 'system' is free market, it is definitely profit-motivated. And costs something ridiculous per head per year ($7000 rings a bell). By contrast, the more socialised models common in Europe, wich are not profit-motivated, manage to provide much better care for literally half the cost or less.

The evidence, it seems, is against running healthcare systems for profit, if one wants the full population to be covered cheaply and effectively.

They do not provide better care. Provide to more people? (As % of total) Yes, everyone has coverage. Better care to those that have it? Absolutely not. When is the last time you have heard of an American going abroad for a medical procedure for any reason other than to save money? The Brits (with money obviously) come here all the time.

That's only for the most updated, most expensive medical procedures. For basic medical care, which is what most people need to avoid the most expensive medical procedures, people get better care and better coverage. Doctors aren't pressured to use the latest, most expensive medicines or treatments and they're not bribed to treat their patients as beta-testers for new drugs. The focus is on healing people instead of making money. That alone makes their health care superior.

[Eofaerwic]

Leaving aside the argument about whether the current US healthcare 'system' is free market, it is definitely profit-motivated. And costs something ridiculous per head per year ($7000 rings a bell). By contrast, the more socialised models common in Europe, wich are not profit-motivated, manage to provide much better care for literally half the cost or less.

The evidence, it seems, is against running healthcare systems for profit, if one wants the full population to be covered cheaply and effectively.

They do not provide better care. Provide to more people? (As % of total) Yes, everyone has coverage. Better care to those that have it? Absolutely not. When is the last time you have heard of an American going abroad for a medical procedure for any reason other than to save money? The Brits (with money obviously) come here all the time.

Not quite. The US system has two very different levels of quality. They have very good quality for one class of citizen (i.e those who can afford it), and another much poorer one for everyone else (those who cannot). The average of these two is worse than the average of any other developed nation, as we can glean from things like infant mortality rates and life expectancy.

Of course let's not forget that the UK has a two level system as well - with those who have private medical insurance receiving an even higher level of care than the average. So: Very good care for the rich, pretty good care for everyone else versus excellent care for rich and poor care for everyone else.

I know which one I'd choose.

[Sibirsky]

Leaving aside the argument about whether the current US healthcare 'system' is free market, it is definitely profit-motivated. And costs something ridiculous per head per year ($7000 rings a bell). By contrast, the more socialised models common in Europe, wich are not profit-motivated, manage to provide much better care for literally half the cost or less.

The evidence, it seems, is against running healthcare systems for profit, if one wants the full population to be covered cheaply and effectively.

They do not provide better care. Provide to more people? (As % of total) Yes, everyone has coverage. Better care to those that have it? Absolutely not. When is the last time you have heard of an American going abroad for a medical procedure for any reason other than to save money? The Brits (with money obviously) come here all the time.

Not quite. The US system has two very different levels of quality. They have very good quality for one class of citizen (i.e those who can afford it), and another much poorer one for everyone else (those who cannot). The average of these two is worse than the average of any other developed nation, as we can glean from things like infant mortality rates and life expectancy.

Fair enough.

[Luporum]

they can simply go 'oops, screw you, we're not giving you proper treatment anymore sucker'.

How is that AT ALL different than what insurance companies do?

[Deibleria]

The main problem with U.S. healthcare is to some degree that it is too good. If you cannot afford the care, obviously there are problems with getting the tests you need. However, if your insurance covers everything, you go through needless tests. Currently the U.S. spends approximately double the amount of any other country on health care. In the process we get care that is increasingly mismanaged by the private corporations.

I personally believe in the free market, but obviously only to a point. We have shown with the market system that certain things will never be taken care of, and we do not trust corporations to provide for us in that fashion. To give a few examples, ozone depletion, roads, war. I am not going to go the whole "environmentalist" route, as that opens a completely different pandora's box. While the problem is not gone, ozone depletion was largely solved by government intervention on certain aerosols. We did not trust the free market to provide us a solution. Roads we never have, government pays for the upkeep and maintenance because we do not trust corporations to give us safer raods. War was the greatest government expenditure of the 20th century. As a form of getting your political goals across, agreeable or not, I personally would not trust the entirety of a war effort to a private corporation. I do realize the U.S. uses mercenaries in the Middle East, but those not the norm. If my point was lost somewhere I apologize, ill reiterate. We do not, and cannot, trust the private sector to solve all of our problems and health care is one of them.

I am not sure of the plan I believe in. Personally I think giving healthcare to everyone is fantastic, but we need to keep things in perspective. With costs continually going up (also a problem) we should focus also on making sure that businesses can change their plan to the new government one, and dont have to pay for their worker's insurance thereby giving small businesses room to expand. Obviously if you can afford insurance, you don't have a problem. This has the potential to be a victory in the unemployment problem as well as a victory on a moral issue.

[Gift-of-god]

Of course let's not forget that the UK has a two level system as well - with those who have private medical insurance receiving an even higher level of care than the average. So: Very good care for the rich, pretty good care for everyone else versus excellent care for rich and poor care for everyone else.

I know which one I'd choose.

Interesting. This kind of model still allows for private insurance, but greatly reduces the size of the market. In the French and Belgian model, you mentioned a public insurance system. Is there any private insurance?

I ask this because of Murayvet's criticisms of the Obama plan, which are valid ones, and in my opinion, are due to the continued pressure of the insurance companies on the government. They don't want to give up their cash cow and are probably investing in lobbyists and 'campaign contributions' like mad to slow healthcare reform in the USA.

So, my question is which of the two models (French/Belgium or UK NHS) do you think would allow for a greater private insurance market, since the insurance companies will want the biggest one they can get?

[Muravyets]

The thing is, what is being pushed not is not really health care reform, it's healthcare insurance reform. The method that the Democratic Party government seeks is to control the purse strings of health care and the populace, not to really make it any more affordable.

If they really wanted to make health care more affordable, they'd take a look at the doctors' and hospitals' expenses. The doctors are being sucked dry by the malpractice insurance rates that they are forced to pay because of unscrupulous (not all) ambulance chasing lawyers. Former Presidential candidate John Edwards was such a crook. Did you know that in a court sumation he "channeled" the spirit of a living girl from the time when she was in the womb?

http://www.pittsburghlive.com/x/pittsburghtrib/s_202515.html

If you really want health care reform, then you need tort reform. The doctor's fees can then become lower. They won't need to schedule costly batteries of tests to cover their asses, either.

No. Although I agree that what we are being offered is health insurance reform not health care reform, I disagree, as usual, with your understanding of the situation, and here's why:

1) I do not believe that the cure is tort reform. I think that bringing tort reform into this issue, which I have heard several people, including on Capitol Hill, try to do, is nothing but another dodge and an attempt to deflect the health care issue. Tort practice needs to be reformed in many ways, in my opinion, but NOT in the ways that people of You-Gi-Owe's political stance typically insist (which boils down to it shouldn't exist). And although the crippling costs of malpractice insurance on individual doctors IS one of the things that I believe needs to be fixed, I do not accept that fixing it will significantly reduce the COST OF HEALTH CARE TO INDIVIDUAL EMPLOYERS AND TO INDIVIDUAL PEOPLE.

Why? Because the costs borne by American citizens are determined by private insurance companies that are under no obligation to account for their premiums with line item invoices that show exactly what we are being charged for and that will go up when something is added and down when something is deleted. There is no guarantee at all that, if the cost of malpractice insurance in doctor's expenses were to be deleted from the patient billing process altogether, that would lead to insurance companies lowering premiums at all.

2) Overhead doing-business costs of doctors and hospitals, such as malpractice insurance, are NOT the only thing, or even the biggest thing patients are billed for. Most experts say that the real cause of the rapid rise of health care is technology. In other words, the cost of the care itself has gone up, not just the cost of doing business as a doctor or hospital. That being the case, reducing doctor/hospital overhead is not going to reduce real care costs by as much as the tort reform fans would like us to think, because although the burden of malpractice insurance is huge on each doctor, it is much smaller than the cost of real care plus insurance premiums on each patient. All insurance and tort related costs could be adjusted, but if the experts are right, then the real care costs are bedrock. They cannot be lowered by any means other than just not getting the care -- i.e. denying care. Thus, the idea of lowering costs at the level of the doctors and hospitals is fine and should be done, but it will not make as big a difference as You-Gi-Owe suggests.

3) You-Gi-Owe misses something that these pols pushing what amounts to insurance reform also miss (or they ignore it and hope we won't notice). That is that their idea of "insurance reform" amounts in practical terms to little more than attempts to somehow arrange things so the insurers can continue to leech off the American health care system at the same rates of profit they do now. As I said in Item (1), we can fiddle with the real costs all we like, and it won't make a lick of difference to the consumers if all their care still has to come through the hands of insurers who are, effectively, free to charge whatever the fuck they want and to refuse to deliver service when they want, too (but keep the client's money anyway).

In the current US system, it is impossible to separate the cost of medicine from the cost of insurance. If the costs of real care have risen so high due to new technology, and thus is not going to go down again (complicated surgery will always cost more than an individual could afford to pay for it), then it will likely never be possible to separate them because in order to afford more advanced care, we will always have to pool our resources and pay cooperatively, which is in a way exactly what the insurance industry does. We all pay in continuously at the same time, but we don't all submit claims at the same time.

But the real problem is that the insurance industry is so unregulated that, although Americans feel absolutely pressured to have insurance, to pay premiums every month, or to look for jobs only with employers who can afford to provide group insurance (avoiding working for new start-ups or never starting their own new businesses or never moving to a better place to live for fear of losing insurance), we have no control at all over how much that insurance is going to cost us from month to month, or that it will continue to exist for us from year to year, or that it will actually pay off on all we have put into it when we actually need it.

MSNBC opinion show host Dylan Ratigan said something today (while I was having breakfast) that I think characterizes the effect of the unregulated insurance industry very well: He said it was like a "cancerous boil" hanging off American health care, sucking money out of the system, money that we never see come out again.

47 million Americans are without health insurance not because they can't afford MRIs or chemo, but because they cannot afford insurance. The only reason anyone is unable to afford something that we cannot do without in the modern world, that is so necessary to life-saving care, is because the insurance industry is allowed to operate completely free of regulation, with no requirements to meet any standards, to match income levels, etc. It's like giving a massive corporate industry control over the nation's drinking water supply and then allowing them to extort money out of people for access to water and also to deny people water as it suits them.

60% of all personal bankruptcies in the US in 2008 were driven by medical costs, including for people who had insurance. One very obvious way that you can pay for insurance for years and still be bankrupted by medical bills is if your insurance company is not delivering the service you were paying for.

As long as private insurance companies are allowed to operate the way they do, then we can fix real medical costs till the sun dies, and it will not make a difference as long as insurance costs are not tied to real costs, and as long as companies are allowed to make up bullshit excuses to refuse policies to people (thus effectively denying them access to medicine) and to deny coverage for specific claims. They will always be nothing but that "cancerous boil" syphoning money out of the system and giving nothing back into it.

[Eofaerwic]

Of course let's not forget that the UK has a two level system as well - with those who have private medical insurance receiving an even higher level of care than the average. So: Very good care for the rich, pretty good care for everyone else versus excellent care for rich and poor care for everyone else.

I know which one I'd choose.

Interesting. This kind of model still allows for private insurance, but greatly reduces the size of the market. In the French and Belgian model, you mentioned a public insurance system. Is there any private insurance?

I ask this because of Murayvet's criticisms of the Obama plan, which are valid ones, and in my opinion, are due to the continued pressure of the insurance companies on the government. They don't want to give up their cash cow and are probably investing in lobbyists and 'campaign contributions' like mad to slow healthcare reform in the USA.

So, my question is which of the two models (French/Belgium or UK NHS) do you think would allow for a greater private insurance market, since the insurance companies will want the biggest one they can get?

There are still private insurance companies in Belgium - I'm not certain of the exact particulars, tbh from what Nervun was saying it sounds similar to the Japanese model, so he may be better placed to answer (I never had to sort my own insurance as while I was living in Belgium I was on my mothers). I believe it's the case that you can either opt into private insurance as a replacement for publicly run insurance and it is very common. However I also believe it is very strongly regulated as to what they can charge and what they have to pay out on.

I'd say that the public insurance model (which is actualy used in most of Europe, I just have personal experience with Belgian medical care) would definitly allow for bigger private insurance market - however to work they would have to accept significant levels of regulation and reduction of profit margins.

[Sibirsky]

The main problem with U.S. healthcare is to some degree that it is too good. If you cannot afford the care, obviously there are problems with getting the tests you need. However, if your insurance covers everything, you go through needless tests. Currently the U.S. spends approximately double the amount of any other country on health care. In the process we get care that is increasingly mismanaged by the private corporations.

I personally believe in the free market, but obviously only to a point. We have shown with the market system that certain things will never be taken care of, and we do not trust corporations to provide for us in that fashion. To give a few examples, ozone depletion, roads, war. I am not going to go the whole "environmentalist" route, as that opens a completely different pandora's box. While the problem is not gone, ozone depletion was largely solved by government intervention on certain aerosols. We did not trust the free market to provide us a solution. Roads we never have, government pays for the upkeep and maintenance because we do not trust corporations to give us safer raods. War was the greatest government expenditure of the 20th century. As a form of getting your political goals across, agreeable or not, I personally would not trust the entirety of a war effort to a private corporation. I do realize the U.S. uses mercenaries in the Middle East, but those not the norm. If my point was lost somewhere I apologize, ill reiterate. We do not, and cannot, trust the private sector to solve all of our problems and health care is one of them.

I am not sure of the plan I believe in. Personally I think giving healthcare to everyone is fantastic, but we need to keep things in perspective. With costs continually going up (also a problem) we should focus also on making sure that businesses can change their plan to the new government one, and dont have to pay for their worker's insurance thereby giving small businesses room to expand. Obviously if you can afford insurance, you don't have a problem. This has the potential to be a victory in the unemployment problem as well as a victory on a moral issue.

Government intervention to solve the ozone depletion problem released massive amounts of greenhouse gases. And created the whole global warming thing. Haha.

[Treznor]

Government intervention to solve the ozone depletion problem released massive amounts of greenhouse gases. And created the whole global warming thing. Haha.

That was really creative! Congratulations! You could make a real career out of writing for the Enquirer.

[Gift-of-god]

Government intervention to solve the ozone depletion problem released massive amounts of greenhouse gases. And created the whole global warming thing. Haha.

This is a) irrelevant, and b) not true.

[Sibirsky]

Government intervention to solve the ozone depletion problem released massive amounts of greenhouse gases. And created the whole global warming thing. Haha.

This is a) irrelevant, and b) not true.

It is true. But irrelevant.

[Sibirsky]

I still say government intervention is a big part of the rapidly rising costs. How big? I have no idea. I mean they started a whole industry. The tax preparation industry. Billions of dollars being spent on compliance. Preparing taxes. Because no normal person can possibly understand the intentionally complicated tax code. The industry writes the tax code itself. Why? So you pay them to do your taxes of course. And if you get audited? You pay them again to represent you.

Medical regulation is the same. And compliance costs are high. A big chunk of the rising costs. If it's medical technology that's driving up costs why are computers and electronics getting cheaper? hey are getting better. And cheaper.

[Gift-of-god]

I still say government intervention is a big part of the rapidly rising costs. How big? I have no idea.

If you have no idea, how do you know that government intervention is a part of the problem?

I mean they started a whole industry. The tax preparation industry. Billions of dollars being spent on compliance. Preparing taxes. Because no normal person can possibly understand the intentionally complicated tax code. The industry writes the tax code itself. Why? So you pay them to do your taxes of course. And if you get audited? You pay them again to represent you.

Are you talking about some sort of conspiracy betwen chartered accountants and the government?

Medical regulation is the same. And compliance costs are high. A big chunk of the rising costs. If it's medical technology that's driving up costs why are computers and electronics getting cheaper? hey are getting better. And cheaper.

Do you have a source or link showing a breakdown of the costs? Or one that shows the rapidly lowering cost of medical technology? If not, then you have no evidence. Why should I believe you?