Health insurance

I know this is hopelessly naive but after reading about Obama care: Why isn't health insurance compulsory for all adults in the U.S even a very basic policy surely that would go a long way to solving the issue.

oscarBravo

mariaalice wrote: »

I know this is hopelessly naive but after reading about Obama care: Why isn't health insurance compulsory for all adults in the U.S even a very basic policy surely that would go a long way to solving the issue.

Because Americans don't like government compulsion to spend money on things.

The ACA makes it kinda-sorta compulsory by imposing fines on people who choose not to be insured. Turns out the fines are cheaper in many cases than the insurance.

newacc2015

A lot of Americans believe that Government ie the Federal Government should have minimal intervention in the daily running of the economy. Health insurance should be seen as an unnecessary intervention in the markets for most people.

The fact is many Americans get free healthcare or low cost from the Government when they are ultralow income and old such as Medicaid and Medicare. Many states also provide their own form of low insurance for low income workers. A lot of companies provide free health insurance for their workers, but a lot companies give their workers low hours to minimise having to pay for it like Walmart

The probably with US healthcare is the high cost not lack of insurance. Medicine prices are insane in the US and having them closer to European levels would help millions of Americans

ancapailldorcha

The idea was that younger, healthier Americans would offset the risk to insurers posed by older and sicker people. Instead, many have eschewed insurance and opted for the often cheaper fines instead leaving those who do take out insurance with more expensive premiums.

InTheTrees

newacc2015 wrote: »

The fact is many Americans get free healthcare or low cost from the Government when they are ultralow income

No. That isnt a fact. That isn't true at all.

If you can't afford health care you go to the emergency room where they legally have to treat you. But they'll send you a bill. You can skip out on the bill of course, then your credit will be shot.

If you have some long term condition like diabetes then you can expect a lot of emergency room visits and growing debt.

InTheTrees

newacc2015 wrote: »

Many states also provide their own form of low insurance for low income workers.

If you mean under the Affordable Care Act then that will be going away as soon as trump can repeal it.

InTheTrees

newacc2015 wrote: »

A lot of companies provide free health insurance for their workers.

Its not really "free". It can cost around $10,000/year to provide can employee with health insurance, if you get your insurance under your spouses policy you can often opt out and get a raise in salary for instance.

Overheal

InTheTrees wrote: »

If you mean under the Affordable Care Act then that will be going away as soon as trump can repeal it.

Said he won't repeal it though.

Anyway, if the government is going to force people to purchase insurance it may as well be taxed and apply to everyone: aka universal healthcare.

As for skipping on bills I don't necessarily reccomend it. I do however have an outstanding balance in a hospital for $2500 and a separate trumped up charge from a clinic that I already paid their flat rate visit fee for of $250; which did not stop them from claiming the payment doesn't exist and I somehow owe $755 for labwork done at the time, despite being a service covered in their visit flat rate.

American healthcare is a shambles. It's better than it was in some respects, worse in others. Profit motives gone wild: I'm surprised insurance companies are this terrible at negotiating down the costs of care. It doesn't work this way in other industries: in the auto industry, insurers and regulators strong-arm auto makers into adopting higher safety standards. I'm confused as to why health insurers aren't pushed to drive healt care costs down in a similar manner.

ancapailldorcha

Overheal wrote: »

American healthcare is a shambles. It's better than it was in some respects, worse in others. Profit motives gone wild: I'm surprised insurance companies are this terrible at negotiating down the costs of care. It doesn't work this way in other industries: in the auto industry, insurers and regulators strong-arm auto makers into adopting higher safety standards. I'm confused as to why health insurers aren't pushed to drive healthcare costs down in a similar manner.

Because if your car gets too expensive, you trade it in for a bus pass or carpool and split the cost. That option doesn't exist for your body so there's no incentive to keep costs down.

InTheTrees

Overheal wrote: »

As for skipping on bills I don't necessarily reccomend it.

No. Exactly. In a lot of cases poor people dont have any choice though, for them healthcare IS the emergency room. The cost, through corporate debt write off, inevitably ends up with the US taxpayer.

Permabear

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Overheal

Permabear wrote: »

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There are conditions for waiving it. I've had it waived 2 years

Permabear

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Peregrinus

Overheal wrote: »

American healthcare is a shambles. It's better than it was in some respects, worse in others. Profit motives gone wild: I'm surprised insurance companies are this terrible at negotiating down the costs of care. It doesn't work this way in other industries: in the auto industry, insurers and regulators strong-arm auto makers into adopting higher safety standards. I'm confused as to why health insurers aren't pushed to drive healt care costs down in a similar manner.

Because it's not in their interests to do so. Basically, their business model works on a "cost-plus" basis - they make a margin of (let's say) 10% on all the money that goes to doctors and hospitals and drug suppliers and so forth. So, the more money that gets spent on medicine, the more money the insurer makes.

There's a bit of a tension here. At the level of the individual claim, the insurer has an interest in getting the payout down. But, looking at claims as a whole, the bigger the turnover the bigger the profit.

The result is that when insurers are negotiating about individual claims they'll argue over whether this particular treatment was necessary, was aprpopriate, was beneficial. But they generally won't argue about what it cost. The result is that hospitals, etc, price treatments very highly, accepting that in a large proportion of cases the insurer will refuse to pay for the treatment, and those cases have to be covered by the cases where payment is made. And the result of that is that, if you're not insured, you end up being charged the extremely high unit price and you're not in a position to argue that the treatment was unnecessary or inappropriate.

Permabear

Permabear wrote: »

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That is only effective if you could buy a policy for 695, the fine needs to be greater than the cheapest policy available.

Permabear

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alastair

Permabear wrote: »

This post had been deleted.

The premium cost of coverage over the fine isn't that great for most though:

HHS, in an analysis released Monday, found that 72 percent of HealthCare.gov customers would be able to find a plan that would cost them less than $75 per month after financial assistance.

And 77 percent of customers will be able to find plans that cost them less than $100 per month, after assistance.

The assistance is available to low- and moderate-income people — ones who earn between 100 percent and 400 percent of the federal poverty level. Officials said Monday that the typical HealthCare.gov consumer earns 165 percent of the poverty level, or about $40,000 for a family of four, or $19,000 for a single person.

About 85 percent of current HealthCare.gov customers qualify for financial aid, in the form of federal tax credits.

An annual $500 above and beyond the fine, for coverage, for 77% (or an extra $200 for 72%) is not what I'd consider unaffordable.

MayoSalmon

mariaalice wrote: »

I know this is hopelessly naive but after reading about Obama care: Why isn't health insurance compulsory for all adults in the U.S even a very basic policy surely that would go a long way to solving the issue.

No economic issues especially health and poverty will be solved by socialist systems of government intervention. NONE

Overheal

MayoSalmon wrote: »

No economic issues especially health and poverty will be solved by socialist systems of government intervention. NONE

Yet there are successful models for this, though some would point to the failures to make you forget that. Similarly there are failed capitalist economies

MayoSalmon

Overheal wrote: »

Yet there are successful models for this, though some would point to the failures to make you forget that. Similarly there are failed capitalist economies

Wheres your evidence?

MayoSalmon

MayoSalmon wrote: »

No economic issues especially health and poverty will be solved by socialist systems of government intervention. NONE

So what has solved them?

alastair

MayoSalmon wrote: »

Wheres your evidence?

The socialised health provision models in pretty much every other advanced nation in the world?

MayoSalmon

mariaalice wrote: »

So what has solved them?

The free market has solved them and continues to do so.

Singapore Health system is the model worldwide healthcare should be striving towards and is a beacon of personal responsibility.

MayoSalmon

alastair wrote: »

The socialised health provision models in pretty much every other advanced nation in the world?

Which are all complete failures.

I hardly need to point out of the substantial cost per captia in delivering the system here, spiraling costs, the long wait lists etc

alastair

MayoSalmon wrote: »

The free market has solved them and continues to do so.

Singapore Health system is the model worldwide healthcare should be striving towards and is a beacon of personal responsibility.

Singapore is a city-state, and therefore has less of a challenge with healthcare provision - similar small-scale nations do just as well in healthcare system rankings on socialised models: San Marino, Andorra, Malta, Monaco, Iceland, Luxembourg.

http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/

alastair

MayoSalmon wrote: »

Which are all complete failures.

Really? Because that's a notion at odds with all the evidence.

MayoSalmon

MayoSalmon wrote: »

The free market has solved them and continues to do so.

Singapore Health system is the model worldwide healthcare should be striving towards and is a beacon of personal responsibility.

Singapore has a non-modified universal healthcare system where the government ensures affordability of healthcare within the public health system, largely through a system of compulsory savings, subsidies, and price controls.

Singapore's system uses a combination of compulsory savings from payroll deductions to provide subsidies within a nationalised health insurance plan known as Medisave

Medishield is a low cost insurance scheme intended for those whose savings are insufficient to meet their medical expense.

Hmmm

MayoSalmon

alastair wrote: »

Singapore is a city-state, and therefore has less of a challenge with healthcare provision - similar small-scale nations do just as well in healthcare system rankings on socialised models: San Marino, Andorra, Malta, Monaco, Iceland, Luxembourg.

http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/

I have a simple question, do you not think that healthcare should be provided by the free market much like the rest of the services we have in society?

And do you think the costs would rise or fall if the private sector took over the industry?

MayoSalmon

mariaalice wrote: »

Singapore has a non-modified universal healthcare system where the government ensures affordability of healthcare within the public health system, largely through a system of compulsory savings, subsidies, and price controls.

Singapore's system uses a combination of compulsory savings from payroll deductions to provide subsidies within a nationalised health insurance plan known as Medisave

Medishield is a low cost insurance scheme intended for those whose savings are insufficient to meet their medical expense.

Hmmm

I am well aware and thats hardly ideal however its system stands above all others in the world.

The chief concept that allows it to prosper and succeed is the fact that the public sector hospitals are operated as private limited companies in order to compete with on service and quality.

Stop socializing the cost of healthcare return every dollar to the tax payer

MayoSalmon

MayoSalmon wrote: »

I am well aware and thats hardly ideal however its system stands above all others in the world.

The chief concept that allows it to prosper and succeed is the fact that the public sector hospitals are operated as private limited companies in order to compete with on service and quality.

Stop socializing the cost of healthcare return every dollar to the tax payer

Did you see the bit about subsidies, price control, universal health care in Singapore.

InTheTrees

MayoSalmon wrote: »

No economic issues especially health and poverty will be solved by socialist systems of government intervention. NONE

MayoSalmon wrote: »

The free market has solved them and continues to do so.
Singapore Health system is the model worldwide healthcare should be striving towards and is a beacon of personal responsibility.

mariaalice wrote: »

Singapore's system uses a combination of compulsory savings from payroll deductions to provide subsidies within a nationalised health insurance plan known as Medisave

MayoSalmon wrote: »

I am well aware and thats hardly ideal however its system stands above all others in the world.

So subsidies, compulsory payroll deductions and government control are good then.

alastair

MayoSalmon wrote: »

I have a simple question, do you not think that healthcare should be provided by the free market much like the rest of the services we have in society?

No. Just as education should not be.

MayoSalmon wrote: »

And do you think the costs would rise or fall if the private sector took over the industry?

The answer to that is evident from the disaster that is the US system. Obamacare offers a partial remedy to that disaster, but it's a complete national mortification regardless.

MayoSalmon

alastair wrote:

The answer to that is evident from the disaster that is the US system. Obamacare offers a partial remedy to that disaster, but it's a complete national mortification regardless.

Eh the US spends 20% of its GDP on Healthcare, it should be performing miraclously according to you.

alastair wrote:

No. Just as education should not be.

Well education is a prime example of an industry that the government continually adds no value, teachers going on strike looking for more tax payers money all the while depriving children of their education shocking really. Privatise the industry, give people back their taxes, allow them save for there children's education, allow schools to compete on tuition and staffing costs. Society will benefit from better quality education, facilities and teachers.

alastair

MayoSalmon wrote: »

Eh the US spends 20% of its GDP on Healthcare, it should be performing miraclously according to you.

Because it buys in an effectively unregulated free market, and has to pay crazy costs as a consequence. The 'free market' effectively becomes a pharma/health services cartel. If it had properly regulated universal provision system (socialised healthcare), it would break that cartel.

alastair

MayoSalmon wrote: »

Well education is a prime example of an industry that the government continually adds no value, teachers going on strike looking for more tax payers money all the while depriving children of their education shocking really.

Private schools are unionised too. Teachers still strike.

Anita Blow

MayoSalmon wrote: »

alastair wrote: »

The socialised health provision models in pretty much every other advanced nation in the world?

Which are all complete failures.

I hardly need to point out of the substantial cost per captia in delivering the system here, spiraling costs, the long wait lists etc

Ireland ranks 25th for healthcare expenditure per capita (compared with the US at number 1) and 19th for quality of healthcare (compared to the US at 37).
In fact, the US spends more on public funds on healthcare than the Netherlands, Germany, UK, France, Ireland yet has worse outcomes across the board than these countries.

The average cost of a Total Hip Replacement in the US is $30,000-70,000, yet in Ireland costs the HSE 12,600 euro with no difference in 5 year outcomes. The same country has hospitals charging $100 for 400mg of Ibuprofen, which equates to ~$4000 for a pack of neurofen. Efficiency is not a word you can associate with the free-market approach taken by the US

In 2011, the Royal Society of Medicine ranked Ireland as Number 1, followed by several other publicly funded systems in the top 10 as the most efficient system for acute medicine in the world, with more lives saved in acute medicine (Cancer, emergency treatment, necessary medical care) than any other in the world.

MayoSalmon

alastair wrote: »

Because it buys in an effectively unregulated free market, and has to pay crazy costs as a consequence. The 'free market' effectively becomes a pharma/health services cartel. If it had properly regulated universal provision system (socialised healthcare), it would break that cartel.

So costs are higher because the market it unregulated and free

alastair

MayoSalmon wrote: »

So costs are higher because the market it unregulated and free

Precisely. Without regulation the companies formed a cartel and price fix.

MayoSalmon

alastair wrote: »

Precisely. Without regulation the companies formed a cartel and price fix.

Where is your evidence of any of this???

alastair

MayoSalmon wrote: »

Where is your evidence of any of this???

It's been widely publicised, and highlighted in congressional investigations, but the U.S. government has no power to legislate against it. There's your free market in action.

http://www.forbes.com/sites/epatientdave/2013/07/22/the-cartel-whose-secret-meetings-set-the-price-of-u-s-medicine/#3ef54317753a

http://www.slate.com/articles/news_and_politics/prescriptions/2009/09/the_fix_is_in.html

Overheal

MayoSalmon wrote: »

So costs are higher because the market it unregulated and free

Have you never heard of Monopolies and Oligopolies? Collusion? It's not like opening up a dollar store, there are only so many actors that can produce drugs.

ancapailldorcha

MayoSalmon wrote: »

So costs are higher because the market it unregulated and free

MayoSalmon wrote: »

Where is your evidence of any of this???

Post more constructively please. You're approaching soapboxing territory. Other posters have cited sources to reinforce their opinions. I suggest you do the same.

Manic Moran

It seems evident that there is not enough competition, the epi-pen saga, recently, was cause for analysts to point out that for competition to result, and not an oligarchy, at least three, maybe four competitors are required. Only two companies make Epi pens.

That said, it is possible to reduce costs by regulation or incentive, as opposed to moving to a government healthcare system. The Government runs the VA healthcare system, which has not been a shining example of late. Even with the advantage that by law they negotiate drug prices as 10% less than normal. Not sure I'd like them running a national one, even if they could afford it.

Peregrinus

MayoSalmon wrote: »

Where is your evidence of any of this???

Lots of evidence has already been posted; have you not noticed?

As others point out, you haven't posted any evidence at all; just flat assertions. It's an article of faith for you that an unregulated free market will always produce lower costs, but if you had any interest in examining the question you'd have long ago discovered that the US healthcare market is the textbook example held up to demonstrate that this isn't universally true. The US healthcare system is famously inefficient; they spend vastly more than other countries and get much lousier result, and this remains true whether we look at overall health expenditure, or just at taxpayer-funded healthcare.

Seriously, you've been interested in free markets and this has never come to your attention? Unless you're the ecomonic equivalent of a biblical fundamentalist, this is absolutely bread-and-butter stuff. The challenge for the right is not to deny that this is so, but to account for why it is so, and what can be done to change it.

n1ey

Anita Blow wrote: »

The average cost of a Total Hip Replacement in the US is $30,000-70,000, yet in Ireland costs the HSE 12,600 euro with no difference in 5 year outcomes. The same country has hospitals charging $100 for 400mg of Ibuprofen, which equates to ~$4000 for a pack of neurofen. Efficiency is not a word you can associate with the free-market approach taken by the US

Every hospital is allowed to set its own prices. They also know that the spigot will not turn-off. Health insurance provides unlimited funds in a sense. They must tap those funds. This is not a free market scheme.
it is a subsidy scheme. It creates a distortion.

In a sense free market issues have created larger doctor/hospital groups. However, these are really driven by distortions. There are tax savings to be had! You incorporate as a nonprofit 100 physician group and save on income tax, sales tax, & property tax. You don't reduce costs because every Doctor still has a support staff. You tell the insurance company that they must pay or they lose access to 100 physicians. They use their market power with enhancement due to distortion. The customers do not know the actual prices or the level of quality.

Your doctor's group works a deal with a hospital group. You start performing regular procedures inside a hospital. You require a separate doctor for airway and sedative monitoring. The doctors manipulate the system. Doctors set the pricing in Medicare. All insurance companies base their codes on Medicare. The EOHHS inspectors allow a wide leeway from the medicare prices. Everything is reasonable as long they are not 1000% above the Medicare code charge. However, they can charge $1000 for something that costs $135, elsewhere?

How many Doctors are required to perform a colonoscopy in Ireland? How many are actually required in America? Often 2 doctors are there! Plus, you need at least one nurse. The Doctors mandated this.

The pharma actually collect the lions share of profits in the US. They sell at lower prices in Ireland. So, the American customer subsidizes the Irish customer. Big Pharma often make deals to access countries and sell their medicines. The governments set prices. The only one that does not set prices? It is the U.S. We pay top dollar but they are willing to take 75% of the price in Ireland.

The solution? Price control. Uniform prices are required within the same geographical region. For instance once hospital should not allowed to charge $75 for an x-ray while another charges $375; the second is only 12 miles away. Everyone should charge $75. This is actually especially important with MRI systems.

Bill

Chuchote

Atul Gawande (one of the world's top cardiac surgeons) has an interesting (loooong) piece in the New Yorker about why GP care and 'incremental care' (ongoing medical service to a patient) is more important than dramatic intervention by specialists; he tells this story from his own family:

http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care

I see the stakes in my own family. My son, Walker, was born with a heart condition, and in his first days rescue medicine was what he needed. A cardiology team deployed the arsenal that saved him: the drips that kept his circulation going, the surgery that closed the holes in his heart and gave him a new aortic arch. But incremental medicine is what he has needed ever since.

For twenty-one years, he has had the same cardiologist and nurse practitioner. They saw him through his first months, when weight gain, stimulation, and control of his blood pressure were essential. They saw him through his first decade, when all he turned out to need was someone to keep a cautious eye on how his heart did as he developed and took on sports. They saw him through his growth spurt, when the size of his aorta failed to keep up with his height, and guided us through the difficult choices about what operation he needed, when, and who should do it. Then they saw him through his thankfully smooth recovery.

When he began to struggle in middle school, a psychologist’s evaluation identified deficits that, he warned us, meant that Walker would probably not have the cognitive capacity for college. But the cardiologist recognized that Walker’s difficulties fit with new data showing that kids with his heart condition tend to have a particular pattern of neurological deficits in processing speed and other functions which could potentially be managed. In the ensuing years, she and his pediatrician helped bring in experts to work with him on his learning and coping skills, and school planning. He’s now a junior in college, majoring in philosophy, and emerging as a writer and an artist. Rescue saved my son’s life. But without incremental medicine he would never have the long and full life that he could.

In the next few months, the worry is whether Walker and others like him will be able to have health-care coverage of any kind. His heart condition makes him, essentially, uninsurable. Until he’s twenty-six, he can stay on our family policy. But after that? In the work he’s done in his field, he’s had the status of a freelancer. Without the Affordable Care Act’s protections requiring all insurers to provide coverage to people regardless of their health history and at the same price as others their age, he’d be unable to find health insurance. Republican replacement plans threaten to weaken or drop these requirements, and leave no meaningful solution for people like him. And data indicate that twenty-seven per cent of adults under sixty-five are like him, with past health conditions that make them uninsurable without the protections.

InTheTrees

newacc2015 wrote: »

The fact is many Americans get free healthcare or low cost from the Government when they are ultralow income and old such as Medicaid and Medicare.

Not really. There's old age healthcare which is under threat from republicans.

And there's not much else. Without obamacare if you have some long term condition, like diabetes you're just out of luck.

Without the affordable care act we will revert to poor people having to get healthcare from hospital emergency rooms, which just drives them deeper into debt.

InTheTrees

MayoSalmon wrote: »

So costs are higher because the market it unregulated and free

Before Obamacare the US "free market" meant that if your healthcare costs got too high then you declare bankruptcy and the hospital writes the debt off on their taxes and the US Taxpayer foots the bill.

Which is why the US spends more on healthcare then anywhere else and has worse results.

Save

InTheTrees

MayoSalmon wrote: »

I have a simple question, do you not think that healthcare should be provided by the free market much like the rest of the services we have in society?

I think the problem with a really "free market" approach is that you really have to let those that cant afford care to go without.

But society has decided that poor people dying in the street isnt acceptable so Hospitals are legally required to provide emergency care without asking for payment first.

Chuchote

InTheTrees wrote: »

I think the problem with a really "free market" approach is that you really have to let those that cant afford care to go without.

But society has decided that poor people dying in the street isnt acceptable so Hospitals are legally required to provide emergency care without asking for payment first.

The other problem with the "free market" approach is that it makes things much more expensive for those who have to pay to support a limited system. Economies of scale work better.

It's like why dragon fruit are expensive but kiwis are cheap - zillions of kiwis are imported and they can be sold for less, compared for the few dragon fruit, which don't have a system set up so you pay €2.50 per fruit.