Question on healthcare/health insurance

[HomerJS]

Where on planet Earth does market based heath insurance work?

 

[soundforbjt]

The Bubble, silly.

 

[TheVrolok]

I'm a rich (comparatively) healthy (comparatively) white guy. Works great for me (comparatively).

 

[ch33zw1z]

Earth? Not sure, checkout Uranus

 

[Hayabusa Rider]

I'm a rich (comparatively) healthy (comparatively) white guy. Works great for me (comparatively).

If you were a healthy and wealthy black transgender it would work great. Cash is king. The problem that some don't understand is that to supply care is expensive because the current paradigms aren't suited to today's standard of care. To correct that we could globally fund R&D for medications, pay stupid amounts of money if need be to draw the best in the field and have a GNU type license with a heap of clauses so as to not allow the creation of ownership monopolies of needed raw materials, then let companies bid for manufacturing rights, again with lots of legalese. That removes profit pressures and actions like ads which are very expensive as well as artificially high prices and uniform safety testing regardless of what it is or where it were created.

In principle it's easy, but there will be incredible resistance which would require leaders instead of politicians who butter their bread with the profits they decry and that's because the system sucks, but things could be far far better.

 

[cbrunny]

Where on planet Earth does market based heath insurance work?

define "work"?

 

[cbrunny]

If you were a healthy and wealthy black transgender it would work great. Cash is king. The problem that some don't understand is that to supply care is expensive because the current paradigms aren't suited to today's standard of care. To correct that we could globally fund R&D for medications, pay stupid amounts of money if need be to draw the best in the field and have a GNU type license with a heap of clauses so as to not allow the creation of ownership monopolies of needed raw materials, then let companies bid for manufacturing rights, again with lots of legalese. That removes profit pressures and actions like ads which are very expensive as well as artificially high prices and uniform safety testing regardless of what it is or where it were created.

In principle it's easy, but there will be incredible resistance which would require leaders instead of politicians who butter their bread with the profits they decry and that's because the system sucks, but things could be far far better.

this is nonsense. universal healthcare works in many countries AND no one is "globally funding" R&D for anything.

 

[glenn1]

Where on planet Earth does market based heath insurance work?

Where it's actually insurance and not an all-inclusive prepaid care plan covering every single conceivable medical expense. If 'health insurance' went back to the actual purpose of insurance to risk shift for unplanned and non-routine/recurring expenses then it would actually work like insurance. There's a reason why auto insurance "works" and health insurance doesn't and it's all about what we expect the insurance to pay for. If we turned auto insurance into health insurance where it pays for your gas, replacement wiper blades, oil changes, etc. then it would be just as screwed up as health insurance.

 

[Hayabusa Rider]

this is nonsense. universal healthcare works in many countries AND no one is "globally funding" R&D for anything.

The reason it's cheap elsewhere is because it's expensive here. Cut corporate income and the number of new drug entities will plummet. What do you think will happen, the stockholders, corporate execs and the like are going to take a loss? No they'll cut funding, slash workers and won't pay to update. They'll get their money. You get the same old "me too" drugs.

 

[K1052]

Where it's actually insurance and not an all-inclusive prepaid care plan covering every single conceivable medical expense. If 'health insurance' went back to the actual purpose of insurance to risk shift for unplanned and non-routine/recurring expenses then it would actually work like insurance. There's a reason why auto insurance "works" and health insurance doesn't and it's all about what we expect the insurance to pay for. If we turned auto insurance into health insurance where it pays for your gas, replacement wiper blades, oil changes, etc. then it would be just as screwed up as health insurance.

And low income Americans are going to pay for those services out of the same pocket full of imaginary cash that was going to fund those amazing HSA's. A huge part of the country lives paycheck to paycheck or worse.

The comparison of auto to health is still one of the dumber things I read on a regular basis.

 

[cbrunny]

The reason it's cheap elsewhere is because it's expensive here. Cut corporate income and the number of new drug entities will plummet. What do you think will happen, the stockholders, corporate execs and the like are going to take a loss? No they'll cut funding, slash workers and won't pay to update. They'll get their money. You get the same old "me too" drugs.

that's also nonsense. no shortage of medical companies in countries with universal.

 

[Murloc]

Where on planet Earth does market based heath insurance work?

switzerland but it's heavily regulated (the price of services are fixed yearly) and it's still one of the priciest in the world with premiums increasing every year. Also some of the best quality (for everyone, not just for rich people, if you have lots of money the US is probably better because they can concentrate lots of rare stuff in specialized hospitals due to the size) in the world though.

 

[HomerJS]

Where it's actually insurance and not an all-inclusive prepaid care plan covering every single conceivable medical expense. If 'health insurance' went back to the actual purpose of insurance to risk shift for unplanned and non-routine/recurring expenses then it would actually work like insurance. There's a reason why auto insurance "works" and health insurance doesn't and it's all about what we expect the insurance to pay for. If we turned auto insurance into health insurance where it pays for your gas, replacement wiper blades, oil changes, etc. then it would be just as screwed up as health insurance.

I was unaware any health insurance paid for food.
food = gas
human = car

 

[Hayabusa Rider]

that's also nonsense. no shortage of medical companies in countries with universal.

You think that these megacorps aren't affected by markets worldwide? You can have a company in Angola and provide meds for free if you are compensated on the global market. Been part of health care back when raptors did surgery, so to speak. This how thing work. Our nation is completely different in demographics, law and a whole lot of other things than the UK for example, where the majority of sex workers come from education and health care because the pay and working conditions are better. It ain't all golden in their system which is why we need to do more than copy paste. If we're shooting for a grand scheme to create a unified system, which will be harder than any other social construct we've attempted we'd best start with something a lot smarter. Being President is hard? That's nothing at all. Just saying something doesn't make it so once control is assumed by another entity who hadn't a clue.

 

[cbrunny]

You think that these megacorps aren't affected by markets worldwide? You can have a company in Angola and provide meds for free if you are compensated on the global market. Been part of health care back when raptors did surgery, so to speak. This how thing work. Our nation is completely different in demographics, law and a whole lot of other things than the UK for example, where the majority of sex workers come from education and health care because the pay and working conditions are better. It ain't all golden in their system which is why we need to do more than copy paste. If we're shooting for a grand scheme to create a unified system, which will be harder than any other social construct we've attempted we'd best start with something a lot smarter. Being President is hard? That's nothing at all. Just saying something doesn't make it so once control is assumed by another entity who hadn't a clue.

what?

 

[Hayabusa Rider]

It's hard, nevermind. The bottom line is that no other system will fit our nation for many reasons and pages of TLDR won't do. We need something original and again that's hard for people who have no knowledge. That's not their fault but they aren't experts any more than they are with the nuts and bolts of interplanetary colonization.

 

[ch33zw1z]

Healthcare is so complex, who knew?

 

[Grooveriding]

We have some comprehensive information from 2000 on relative performance between developed nations in the per capita quality of care. http://www.who.int/healthinfo/paper30.pdf. Two salients points are the US ranks 37 overall in quality of their health care system, attains rank 1 in amount spent on health care. It fairly soundly makes the case that the US health care system is extremely inefficient and unduly expensive. This goes beyond a common talking point of pharmaceutical costs, actual costing on procedures, equipment etc. is also higher in the US and the increased costs do not correlate to better quality. Some information I think would have been really interesting, but I'm not certain a legitimate level of bifurcation could be attained to have obtained it, would be points of household income levels over the average in the US at which those increased income marks raised the ranking of quality of care received above the average rank of 37.

A multi-millionaire or billionaire is obviously going to have exceptional care because cost is not a concern and their avenues of available care are virtually unlimited. In the event of a serious health concern they can go anywhere in the world where the best treatment is available for that hypothetical and write a cheque to receive it. But, just how much better is your care if you are a more common higher than the median income earner ? Making say $100K, $200K or $300K etc. annual household income. You'd need to find the median quality of care obtainable via health insurance plans for those income brackets to make any comparisons. Logically we would expect to see some improvement at above average income brackets, but exactly how much of an increase over the 37 rank would be interesting information to have.

Also, having a better standard of living, separated from the quality of health care you receive, also improves your overall health. You are in a better position to have a lifestyle that potentially is not as harmful to your overall health.

I don't think a solely universal care system is viable for the US. The ideological differences represented by a significant amount of the country with such a system are too much at contrast. Just considering the undertaking of what would amount to an annihilation of health insurance companies in the US is enough to prove this. Their profits would be annihilated and the interests representing those profits would be hard to overcome. A two tiered system of singe payer and private insurance would be a better choice, with some sort of tax credits for people who solely make use of the private tier through employer insurance or out of pocket.


This was priceless, not even a few hours after they moved on this healthcare legislation, Trump maintains his foot's position down his throat:

 

[ch33zw1z]

Feel the bern

 

[interchange]

Every system is perfectly designed to get the results it gets. (W. Edwards Deming)

A purely market based healthcare system (buyer beware), of which we are very far from, would produce results that have:
- high access to things consumers with good purchasing power want (not necessarily need)
- an extremely high burden on consumers to be knowing in both what they need and whether a plan would actually deliver those needs
- high cost efficiency

In order to implement this, we would need to be ruthless in allowing people who couldn't afford healthcare or people who made bad decisions in their healthcare coverage suffer and die.

Right now, we have a host of regulations, laws (EMTALA, bankruptcy), safety nets (SSI, Medicare, Medicaid) in order to protect people from the consequences of their poverty or poor decisions. Unfortunately, this also mitigates market pressure for insurance companies to align with patient interests.

 

[glenn1]

And low income Americans are going to pay for those services out of the same pocket full of imaginary cash that was going to fund those amazing HSA's. A huge part of the country lives paycheck to paycheck or worse.

The comparison of auto to health is still one of the dumber things I read on a regular basis.

Thanks for proving my point that we don't have health insurance here but rather prepaid healthcare we call "insurance." That you want to further muddy the waters by complaining about how the poor would pay for it or that we should pay for them still doesn't change the basic nature of what actual insurance is.

 

[K1052]

Thanks for proving my point that we don't have health insurance here but rather prepaid healthcare we call "insurance." That you want to further muddy the waters by complaining about how the poor would pay for it or that we should pay for them still doesn't change the basic nature of what actual insurance is.

You didn't answer the original question. Where does health insurance like you describe function adequately? I can't think of anywhere. Even the Switzerland example is really paying for coverage/services that will be used not just the promise of coverage.

Health insurance sells as a concept because some percentage of the population has the idea that it does function like auto insurance. Young/healthy people think they won't ever get sick just like lots of people think they'll never be in a wreck so they don't need it or settle for useless policies. The percentages of people to be proven wrong about that assumption are just incredibly higher for health insurance. The odds of making it healthily to your death without any substantial medical needs along the way are almost nil.

 

[Fanatical Meat]

You didn't answer the original question. Where does health insurance like you describe function adequately? I can't think of anywhere. Even the Switzerland example is really paying for coverage/services that will be used not just the promise of coverage.

Health insurance sells as a concept because some percentage of the population has the idea that it does function like auto insurance. Young/healthy people think they won't ever get sick just like lots of people think they'll never be in a wreck so they don't need it or settle for useless policies. The percentages of people to be proven wrong about that assumption are just incredibly higher for health insurance. The odds of making it healthily to your death without any substantial medical needs along the way are almost nil.

Agreed Glenn frequently cites free market ideas for healthcare and also tells people not to be losers or do stupid stuff (which is actually good advice) but when it comes to healthcare he seemingly wants to copy what all the loser countries do like Somalia or Afghanistan

 

[glenn1]

You didn't answer the original question. Where does health insurance like you describe function adequately? I can't think of anywhere. Even the Switzerland example is really paying for coverage/services that will be used not just the promise of coverage.

Health insurance sells as a concept because some percentage of the population has the idea that it does function like auto insurance. Young/healthy people think they won't ever get sick just like lots of people think they'll never be in a wreck so they don't need it or settle for useless policies. The percentages of people to be proven wrong about that assumption are just incredibly higher for health insurance. The odds of making it healthily to your death without any substantial medical needs along the way are almost nil.

Again you're proving my point. Just because you're annoyed when it is pointed out to you that health insurance is being misused as the primary method of healthcare delivery and management in the U.S. doesn't make what I said less correct. Just as if you used a handgun to pound in nails you would be wrong to ask "where on earth do market based hammers work" so is the question being posed here about why health "insurance" doesn't work.

To answer the question that was posed, true health insurance works fine as it involves proper underwriting, premia paid related to expected payouts, no coverage of pre-existing conditions by definition, et cetaera and its price would reflect that. That you think that under the current system some people get health insurance policies inadequate to what you think their needs are is irrelevant. Actual health insurance works where people treat it as insurance.

To answer the question that you might want to ask, "how does health insurance work for handling any and all medical related expenses anyone may incur" then the answer is not very well. The U.S. screwed up when for reasons of historical accident (WW2 wage controls leading to the rise of employer subsidized health insurance) that American healthcare basically got managed via health insurance. The entire foundation of U.S. healthcare is built on a stupid delivery channel.

Fix that root cause and most everything else falls into place. You could do "single payer" and that would work. Personally I prefer a 3-pronged system of taxpayer paid catastrophic insurance, robust health savings accounts for routine/acute care, and free clinics for the poor.

 

[NAC4EV]

6 Reasons Healthcare Is So Expensive in the U.S.
By Lita Epstein | August 6, 2015 — 6:40 PM EDT


http://www.investopedia.com/article...0615/6-reasons-healthcare-so-expensive-us.asp




Healthcare in the U.S. costs about twice as much as it does in any other developed country. If the $3 trillion U.S. healthcare sector were ranked as a country, it would be the world’s fifth largest economy according to “Consumer Reports." The cost of this huge financial burden to every household because of lost wages, higher premiums and taxes plus additional out-of-pocket expenses is more than $8,000.

Even with all this money being spent on healthcare, the World Health Organization ranked the U.S. thirty-seventh in healthcare systems, and The Commonwealth Fund placed the U.S. last among the top 11 industrialized countries in overall healthcare.

Why is the U.S. paying so much more for care and not appearing at the top of the rankings? Here’s a look at six key reasons the U.S. is failing to provide adequate healthcare at reasonable prices.

1. Administrative Costs
The number one reason our healthcare costs are so high, says Harvard economist David Cutler, is that “the administrative costs of running our healthcare system are astronomical. About one quarter of healthcare cost is associated with administration, which is far higher than in any other country.”

One example Cutler brought up in a discussion on this topic with National Public Radio was the 1,300 billing clerks at Duke University Hospital, which has only 900 beds. Those billing specialists are needed to determine how to bill to meet the varying requirements of multiple insurers. Canada and other countries that have a single-payer system don’t require this level of staffing to administer healthcare.

2. Drug Costs
Another major difference in health costs between the U.S. and every other developed nation is the cost of drugs. The public definitely believes drug costs are unreasonable; now politicians are starting to believe that too. In most countries the government negotiates drug prices with the drug makers, but when Congress created Medicare Part D, it specifically denied Medicare the right to use its power to negotiate drug prices. The Veteran's Administration and Medicaid, which can negotiate drug prices, pay the lowest drug prices. The Congressional Budget Office has found that just by giving the low-income beneficiaries of Medicare Part D the same discount Medicaid recipients get, the federal government would save $116 billion over 10 years. Think of what the savings might be if all Medicare recipients could benefit from Medicaid-negotiated drug prices!

3. Defensive Medicine
Yet another big driver of the higher U.S. health insurance bill is the practice of defensive medicine. Doctors are afraid that they will get sued, so they order multiple tests even when they are certain they know what the diagnosis is. A Gallup survey estimated that $650 billion annually could be attributed to defensive medicine. Everyone pays the bill on this with higher insurance premiums, co-pays and out-of-pocket costs, as well as taxes that go toward paying for governmental healthcare programs.

4. Expensive Mix of Treatments
U.S. medical practitioners also tend to use a more expensive mix of treatments. When compared with other developed countries, for example, the U.S. uses three times as many mammograms, two-and-a-half times the number of MRIs and 31% more Caesarean sections. This results in more being spent on technology in more locations. Another key part of the mix is that more people in the U.S. are treated by specialists, whose fees are higher than primary-care doctors, when the same types of treatments are done at the primary-care level in other countries. Specialists command higher pay, which drives the costs up in the U.S. for everyone.

5. Wages and Work Rules
Wages and staffing drive costs up in healthcare. Specialists are commanding high reimbursements and the overutilization of specialists through the current process of referral decision-making drives health costs even higher. The National Commission on Physician Payment Reform was the first step in fixing the problem; based on its 2013 report, the commission adopted 12 recommendations for changes to get control over physician pay. Now it is working with Congress to find a way to implement some of these recommendations.

6. Branding
“There is no such thing as a legitimate price for anything in healthcare,” says George Halvorson, the former chairman of health maintenance organization Kaiser Permanente. “Prices are made up depending on who the payer is.”

Providers who can demand the highest prices are the ones that create a brand everyone wants. “In some markets the prestigious medical institutions can name their price,” says Andrea Cabarello, program director at Catalyst for Payment Reform, a nonprofit that works with large employers to get some control on health costs.

The Affordable Care Act (ACA) has pushed back to some degree against the high costs created by branding. In central Florida, for example, one of the top brands is Florida Hospital. This year ACA policies offered by Humana did not include services provided by this brand. Similar types of contract negotiations knocked out top hospitals in other locations. It remains to be seen whether this will cause those hospitals to reduce prices to get those patients back.

The Bottom Line
Most other developed countries control costs, in part, by having the government play a stronger role in negotiating prices for healthcare. Their healthcare systems don’t require the high administrative costs that drive up pricing in the U.S. As the global overseers of their country's systems, these governments have the ability to negotiate lower drug, medical equipment and hospital costs. They can influence the mix of treatments used and patients’ ability to go to specialists or seek more expensive treatments.

So far in the U.S., there has been a lack of political support for the government taking a larger role in controlling healthcare costs. The most recent legislation, the Affordable Care Act, focused on ensuring access to healthcare, but maintained the status quo to encourage competition among insurers and healthcare providers. This means there will be multiple payers for the services and less powerful control over negotiated pricing from providers of healthcare services.