Responding to post 9/11 Republicans

[Cats Cats Cats]

The reason that health insurance and health care are now nearly synonymous is that health insurance is now a virtual necessity to receive care.  Care is now so expensive that it's impossible to pay out of pocket and still remain solvent.  Unlike car insurance, where most anyone can afford the minimum amount of required coverage.  The two industries are similar in that they're called "insurance," but their relationship to the things they insure are very different.

I got a shot of antibiotics or steroids or something like that.  They doctors office charged $80 for the shot.  The insurance negotiated rate was $3.80.  Sooo, yeah you are kind of screwed without insurance.

[we vs us]

I got a shot of antibiotics or steroids or something like that.  They doctors office charged $80 for the shot.  The insurance negotiated rate was $3.80.  Sooo, yeah you are kind of screwed without insurance.

I'm sure the mechanics of why this has happened is much more complicated, but the end result is that it's nearly impossible to get good care without insurance on your side. 

For me, the whole argument about healthcare/insurance was who you wanted subsidizing your medical care:  the government or private industry?  The devil we know -- private industry --  has failed monumentally at the things private industry is supposed to give us:  choice of provider, moderated pricing through competition, and efficient capital allocation.  Instead it's given us bloated bureaucracy and price increases that far outstrip the rate of inflation.  Why not try government?

[Conan71]

I'm sure the mechanics of why this has happened is much more complicated, but the end result is that it's nearly impossible to get good care without insurance on your side. 

For me, the whole argument about healthcare/insurance was who you wanted subsidizing your medical care:  the government or private industry?  The devil we know -- private industry --  has failed monumentally at the things private industry is supposed to give us:  choice of provider, moderated pricing through competition, and efficient capital allocation.  Instead it's given us bloated bureaucracy and price increases that far outstrip the rate of inflation.  Why not try government?

Wevus, if you believe medical providers, they are saying it's the government who has made healthcare a more expensive proposition due to cutting Medicare and Medicaid procedure payments. 

[Cats Cats Cats]

Insurance companies are subsidizing our health care.  They are profiting off it.

[we vs us]

Wevus, if you believe medical providers, they are saying it's the government who has made healthcare a more expensive proposition due to cutting Medicare and Medicaid procedure payments. 

Well, that's probably some of it but there're some other major drivers out there that are outside the gov's influence (worsening health in America, growth of private bureaucracy, aging of the population, etc.)  Blaming Medicare and Medicaid is a lot like blaming Fannie and Freddie Mac for the entire mortgage collapse.  IMO it overemphasises the effect that gov had to satisfy mostly ideological prejudices.  I'm not denying they weren't/aren't part of the problem, but they're really only single cogs vast machine that's malfunctioning in multiple places.  

[Conan71]

Insurance companies are subsidizing our health care.  They are profiting off it.

Just curious, do you think they shouldn't make a profit when they act as your intermediary to negotiate lower procedure costs? 

[Gaspar]

For me, the whole argument about healthcare/insurance was who you wanted subsidizing your medical care:  the government or private industry?  

I would prefer that no one subsidize my healthcare, because that always entails making decisions on my behalf.

I would prefer that no one subsidize any part of my life.  Unfortunately, employers got involved a long time ago.  Employer sponsored plans were a perk, a benefit offered to high-end employees.  Then it became a retention tool, designed to keep employees from leaving for higher wages.  At this point, the quality of the plan became secondary to it's mere existence as employers fought over price, and insurance companies profit. 

Now it has evolved into an entitlement.  Employers can't hire a decent workforce without it. Individuals are priced out of buying it because they do not represent a group who's risks can be actuated and expenses shared. 

On the other side of the cycle, doctors who used to be able to pick and choose what plans they accepted are forced to take lower payments in order to retain their patients.  The insurance companies no longer evaluate the individual.  They now assess the workplace according to groups.  The guy down the hall from you with stage 3 prostate cancer makes your insurance more expensive.  The cost of his care is spread amongst his co-workers.

Physicians are forced to run thousands of tests on patients every year, not because they are necessary or even indicated, but because they have to shield themselves from litigation from the insurance companies.  Insurance companies spend billions of dollars every year on attorneys.   Physicians spend billions on malpractice insurance that goes back to many of the very same insurance companies.  When you look at the margin of the insurance industry it looks reasonable, because the hidden profiteers are the lawyers.  The cost of medicine, insurance, and just general healthcare has been corrupted by the legal system's ability to feed off of the entitlement. So the sheep scream for government, blame physicians, employers, and insurance companies, and totally ignore the lawyers.

We are now on the road to taking this "modular" entitlement and making it a universal entitlement administered by the government.  It will become far more expensive, with far lower quality, and much less choice.  As individuals we used to represent a risk to the insurance companies.  Now we become a liability to the government.  In order to survive, the government will need to make decisions about your care.  As patient #40489859 with lymphoma, you will be less valuable than patient #909484 with lymphoma because you are 4 years older, or you are unemployed.  After all, the statistics show that you will have a lesser chance of survival than #909484.

In order to provide necessary insurance risk assessment, the government will need access to your medical records, drug history, and all of the information you share with your doctor.  Someone in Washington, or more likely a computer designed to assess risk based on a health scoring system will determine your level of care based on your Health Score.

[Conan71]

Wait Gaspar, someone will post within the next few hours about either malpractice settlement costs being equal to 1 to 2% of overall medical expenditures in this country.  What that convenient little stat fails to denote is the additional testing costs for the CYA which is supposed to ward off Med Mal lawsuits, nor years where provider's have faced up to 15% increases in their MM insurance from the prior year, even without any claims of their own.

This article claims up to 10% of your procedure cost is for malpractice premiums:

http://www.realclearmarkets.com/articles/2009/08/06/the_high_cost_of_medical_malpractice_97346.html

"Even though President Obama acknowledged defensive medicine's role in higher health costs in his speech before the American Medical Association, he did not propose any solutions. In fact, he specifically repudiated capping malpractice awards on the grounds that it would be "unfair to people who've been wrongfully harmed."

The reason the president and congressional Democrats don't address malpractice is clear. In the 2008 election cycle, lawyers gave $233 million to political candidates: 76% went to Democrats and 23% to Republicans. Politicians know better than to bite the hand that feeds them.

Rather than attempting to expand litigation opportunities, Congress could use health reform legislation to give incentives to states to reduce malpractice costs, while still protecting patients.

Some states, such as Texas, are showing how to get malpractice costs under control. Since the state legislature passed a series of malpractice reforms several years ago, medical malpractice costs have plummeted, and numbers of doctors moving into the state have soared.

"There is a cause and effect here," said Grace-Marie Turner, president of the non-partisan Galen Institute in Washington, D.C. "Premiums with one malpractice insurance company have fallen by more than a third, allowing doctors and hospitals to reduce costs. About 7,000 physicians have moved into Texas over the last four years, and the state has backlogs of applications from other physicians wanting to move."'

[Cats Cats Cats]

Just curious, do you think they shouldn't make a profit when they act as your intermediary to negotiate lower procedure costs?  

We are getting screwed.  No they shouldn't make a profit for basically privatized regulation.  We are getting it in both ends.  

[Gaspar]

Wait Gaspar, someone will post within the next few hours about either malpractice settlement costs being equal to 1 to 2% of overall medical expenditures in this country.

Yes I anticipate that, but those are "settlement costs" and as we both know that represents only a tiny fraction of the legal burden. Our landscape is littered with the multi-million dollar compounds of malpractice attorneys.

I just looked and my Yellow Pages includes 76 pages of attorneys that specialize in malpractice, and only 32 pages of physicians. Those attorneys get your insurance payment, one way or the other.  The level of litigation is mind blowing. 

[we vs us]

Yes I anticipate that, but those are "settlement costs" and as we both know that represents only a tiny fraction of the legal burden. Our landscape is littered with the multi-million dollar compounds of malpractice attorneys.

I just looked and my Yellow Pages includes 76 pages of attorneys that specialize in malpractice, and only 32 pages of physicians. Those attorneys get your insurance payment, one way or the other.  The level of litigation is mind blowing. 

Viewed another way, it might be an indicator that people go where the money is.

[Conan71]

We are getting screwed.  No they shouldn't make a profit for basically privatized regulation.  We are getting it in both ends.  

How do they exist without making a profit, then?  I'm still not quite sure why it's a bad thing that an $80 shot was knocked down to $3.84 on your behalf.

Insurers also negotiate for better repair rates with body shops and parts manufacturers, roofing contractors, plumbers, etc. when it comes to property claims, yet no one seems to be calling that privatized regulation.  You have insurance on yourself (government-mandated auto liability does not protect your property) and your property due to you either not being able to afford or not wanting to afford thousands or millions in medical costs, property loss, or a liability action against you. 

Insurers take that risk off your hands and agree to make you or your property whole again in amounts many times your premium costs.  You might be one of the people who pays out $100K or more in combined premiums in your lifetime and never files a claim of any sort.  Or you could also be one of them who winds up having a few million paid out on your behalf.  If you are willing to bet you won't need insurance and don't have a lender who requires it on your car or home, assume your own risk.

Personally, I'd rather wind up on the side of paying out well over $100K in premiums in my lifetime and hoping I don't ever have any major claims, especially medical. 

I don't begrudge them for making a profit in a very risky business. 

[Conan71]

Viewed another way, it might be an indicator that people go where the money is.

Doctors don't want to spend time in depositions and attending trials.  I would imagine, much like all other PI civil cases, that a high percentage are settled out of court just to make it go away.  Greenmail if you will.  Large multi-million dollar settlements are fairly rare.  Attorneys can make a consistent living (cannon_fodder feel free to correct me) off of < $10,000 settlements day in and day out for essentially doing little more than writing letters, filing a suit, and making some phone calls to the insurers attorneys.

[Gaspar]

Viewed another way, it might be an indicator that people go where the money is.

Sure, but we're going to change that, right?

When it becomes the government who makes a poor medical decision on your behalf who do you sue?  The doctor was just doing what the government advised, or agreed to pay him for.  You will never get anywhere if you sue the government, they were providing the best care based on existing statistical data.

Something to ponder as we slouch forward.

We can always look at what other countries with government systems do. . .

In using "quality adjusted life years" per British pound to make treatment decisions, NICE (The National Institute for Clinical Health Excellence)  mandates that Britain cannot afford to spend, except in unusual cases, more than $22,000 to extend a life 6 months.  Sorry Nanna.

The Brits were promised there would never be rationing, as were the Canadians. . .

[Cats Cats Cats]

How do they exist without making a profit, then?  I'm still not quite sure why it's a bad thing that an $80 shot was knocked down to $3.84 on your behalf.

Insurers also negotiate for better repair rates with body shops and parts manufacturers, roofing contractors, plumbers, etc. when it comes to property claims, yet no one seems to be calling that privatized regulation.  You have insurance on yourself (government-mandated auto liability does not protect your property) and your property due to you either not being able to afford or not wanting to afford thousands or millions in medical costs, property loss, or a liability action against you. 

Insurers take that risk off your hands and agree to make you or your property whole again in amounts many times your premium costs.  You might be one of the people who pays out $100K or more in combined premiums in your lifetime and never files a claim of any sort.  Or you could also be one of them who winds up having a few million paid out on your behalf.  If you are willing to bet you won't need insurance and don't have a lender who requires it on your car or home, assume your own risk.

Personally, I'd rather wind up on the side of paying out well over $100K in premiums in my lifetime and hoping I don't ever have any major claims, especially medical. 

I don't begrudge them for making a profit in a very risky business. 

Non-Profit.  You still have jobs and people still work and make money.  The difference between health insurance and car and property insurance is that health insurance is life and death.  I do see your point.  I think that auto insurance should be regulated as well.  Since it is required by law.  I don't think that somebody should make a profit from denying you procedures at least with a car you are just out money.  The motive is completely wrong.  Besides the "risk" is that you just close shop or just not pay claims out.  http://blogs.abcnews.com/theblotter/2006/08/state_farm_insi.html
The "risk" is just if you decide to pay.  Which just like the rebate houses, the more, sneakier ways to deny claims, the better off your company is.  Then you can charge less and companies are happier with a cheaper rate and you still make the same amount of money.  The employees are faced with 1) crappy coverage or 2) they lose their very expensive form of compensation.