The Supreme Court decision on ObamaCare

[Conan71]

So, you take self insuring and premium balancing out of the discussion to get to an identical deductible? I see why I have to argue with you so often.....

No, I'm making a simple point that higher risk always equates to higher premiums. Don't make it so difficult on yourself.

Deductibles are simply a way to mitigate how much you end up paying in premiums.

[erfalf]

Some people, especially the young, consider themselves "healthy" and figure the cost of insurance is unnecessary. Kinda of a gamble. Then there is EMTALA. Also, there are wealthy people who don't need it or pay out of pocket.

In a way I want to see how this plays out. Stop the litigation, interference, and give this a chance.

Insurance is a financial tool only. It does nothing to actually provide health care. That is what doctors and hospitals do. It only has to do with paying for said care. Young people take the risk just like some people take the risk of not buying life insurance, or auto insurance (beyond the minimum), or trip insurance. It is always a risk, but a financial one all the same.

I don't really see how ACA can reduce costs for insurance. Making everyone buy will likely add many health payers which logically should lower the premiums for everyone, however, it will be countered somewhat by the fact that now no one can be denied insurance regardless of preexisting conditions. Honestly I don't understand why insurers are that worried about the later, the risk has been reduced, they already know the client will be chronically ill or whatever. Charge them out the nose and move on. Just like someone who wrecks cars a bunch. Do they ever stop them from buying insurance...not that I've heard. It just starts getting pretty expensive.

Disclaimer: Since I don't work in insurance, and personally can't stand dealing with it , I could be totally off base on all of this.

[DolfanBob]

Where do I get a application for CEO of the red tape division in the United States Government healthcare plan?

[Conan71]

Where do I get a application for CEO of the red tape division in the United States Government healthcare plan?

Bundle $250K for Obama '12 and you won't even have to fill out the application.

[TheArtist]

Insurance is a financial tool only. It does nothing to actually provide health care....

Bingo!  A while back I was talking to someone from overseas and they mentioned that. "How is health insurance,,, health care?"  It's like we buy car insurance, but don't have a maintenance plan.  We don't change the oil etc, (don't eat right and exercise) then the engine drops out.   If you have regular maintenance/preventative care/inspections and "healthcare" you can reduce costs.   

[nathanm]

Bingo!  A while back I was talking to someone from overseas and they mentioned that.

Three days ago I was talking to someone from overseas and it shocked them that, for example, Medicare can't negotiate on drug prices. For around $50, I could have had someone come to the place where I was staying to draw blood and whatever else was needed, get the results of the tests online by the next day, then take the printout to an English speaking doctor and get a full physical. None of it subsidized by the government. That's private system cost. Further, if I needed a CT for whatever reason, or say a colonoscopy, that would be another $50. And if I needed the drugs delivered, that would cost me a whopping two bucks, plus the drugs themselves cost less than a tenth what they do here. Even on a typical $1000-$1500 a month (equivalent) local salary, none of that is unaffordable.

In said country, the only point in health insurance if you have even a modest income is to cover the catastrophic care. If a person is destitute, the government pays for it all at no cost to the end user, which helps keep disease from spreading unnecessarily.

The cost of insurance here is outrageous, but it's not only because of for-profit insurers driving up costs through arcane rules and refusal to standardize, it's also due to the outrageous cost of drugs, procedures, and everything else. Given that the same companies can sell the same stuff (MRI machines, drugs, whatever) to people in other countries for so much less, isn't it a bit odd that they charge us so much?

Anyway, I think the HCR law will probably help slow the increase in costs in some areas, but overall it doesn't go far enough in breaking the rent-seeking behavior endemic in the medical profession.

[Conan71]

Three days ago I was talking to someone from overseas and it shocked them that, for example, Medicare can't negotiate on drug prices. For around $50, I could have had someone come to the place where I was staying to draw blood and whatever else was needed, get the results of the tests online by the next day, then take the printout to an English speaking doctor and get a full physical. None of it subsidized by the government. That's private system cost. Further, if I needed a CT for whatever reason, or say a colonoscopy, that would be another $50. And if I needed the drugs delivered, that would cost me a whopping two bucks, plus the drugs themselves cost less than a tenth what they do here. Even on a typical $1000-$1500 a month (equivalent) local salary, none of that is unaffordable.

In said country, the only point in health insurance if you have even a modest income is to cover the catastrophic care. If a person is destitute, the government pays for it all at no cost to the end user, which helps keep disease from spreading unnecessarily.

The cost of insurance here is outrageous, but it's not only because of for-profit insurers driving up costs through arcane rules and refusal to standardize, it's also due to the outrageous cost of drugs, procedures, and everything else. Given that the same companies can sell the same stuff (MRI machines, drugs, whatever) to people in other countries for so much less, isn't it a bit odd that they charge us so much?

Anyway, I think the HCR law will probably help slow the increase in costs in some areas, but overall it doesn't go far enough in breaking the rent-seeking behavior endemic in the medical profession.

It would appear consumers in the United States are paying a disproportionate share (if not all of) of the development and marketing costs of meds while other countries enjoy incredibly cheap prices.  Unless the meds they are getting are coming from substandard plants where the regulatory costs are nil, I really can't think of any other reason why our costs should be so much higher.  Actual drug manufacturing must not be a terribly high-cost endeavor when you consider how much cheaper generic meds are than when it was proprietary to the original manufacturer.

I've never really thought too much about it before but something Mrs. C alluded to is insurance really should be for the major catastrophes, not a payment service for nickel and dime crap like check ups or seeing the doc when you have a sniffle.  The HMO or PPO negotiates a lower rate from my PCP, I still pay a $30 co-pay, the insurance company probably pays $40 so the doc gets $70 for a 5-10 minute visit & eval.  I'd love to know how much of what my employer pays (I admit I'm fortunate to have 100% paid health insurance and 70% covered for my wife) is allotted for major medical and how much is maintenance or "well coverage".  If more than $200 per year in premiums for me are for PCP visits, it would be better off to pay $100 out of pocket for each visit considering I usually only go once per year.  Or perhaps the doctor would simply take $70 cash from me instead of marking up the rate to everyone to account for the lower rates the HMO's & PPO's negotiate for their members.  To me they are more like a buyers discount club than an insurance plan.

[Teatownclown]

[nathanm]

It would appear consumers in the United States are paying a disproportionate share (if not all of) of the development and marketing costs of meds while other countries enjoy incredibly cheap prices.  Unless the meds they are getting are coming from substandard plants where the regulatory costs are nil, I really can't think of any other reason why our costs should be so much higher.  Actual drug manufacturing must not be a terribly high-cost endeavor when you consider how much cheaper generic meds are than when it was proprietary to the original manufacturer.

Is it really necessary to "market" medications beyond submitting articles to medical journals? Also, what makes you think that they're not merely engaging in price discrimination, much as airlines often charge more if you buy your ticket with less advance notice or don't want to stay over a weekend or whatever? Is there any real evidence that, given the same pricing, there would not be enough money for R&D? Which, come to think of it, is a cost largely borne by the government anyway?

I don't think it's unreasonable to believe that price gouging isn't a large part of why medical costs are so high here. Not the only issue, after all, there's the refusal of the insurance industry to consider efficiency an important goal (why, when you can just pass through the cost?), the general decline in public health in the US among the greatest portion of the people, increasing longevity among those with means, and a raft of unnecessary procedures done either to pad a doctor's bottom line (if you own an MRI machine, it seems like a great idea to give all your patients MRIs, I'm sure) or as a means to stave off nuisance malpractice suits.

None of that really addresses the basic disparity in cost per procedure between us and all other countries, advanced or not, hence my thinking basic price gouging may well be a significant factor.

[dbacks fan]

It 's all Bush's fault. He appointed Roberts to the supremes.

[Red Arrow]

None of that really addresses the basic disparity in cost per procedure between us and all other countries, advanced or not, hence my thinking basic price gouging may well be a significant factor.

If "you" know that "you" will have to negotiate a final price, you start high to get what "you" want/need when done negotiating.

[Red Arrow]

It would appear consumers in the United States are paying a disproportionate share (if not all of) of the development and marketing costs of meds while other countries enjoy incredibly cheap prices.  Unless the meds they are getting are coming from substandard plants where the regulatory costs are nil, I really can't think of any other reason why our costs should be so much higher.  Actual drug manufacturing must not be a terribly high-cost endeavor when you consider how much cheaper generic meds are than when it was proprietary to the original manufacturer.

My generic blood pressure medicine costs $10 for 90 days supply at WalMart.  It has a minor side effect of giving a tickle in the throat which can make someone cough.  Another medicine, still patent protected, without the tickle in the throat, is $87 per month.

I've never really thought too much about it before but something Mrs. C alluded to is insurance really should be for the major catastrophes, not a payment service for nickel and dime crap like check ups or seeing the doc when you have a sniffle.  The HMO or PPO negotiates a lower rate from my PCP, I still pay a $30 co-pay, the insurance company probably pays $40 so the doc gets $70 for a 5-10 minute visit & eval.  I'd love to know how much of what my employer pays (I admit I'm fortunate to have 100% paid health insurance and 70% covered for my wife) is allotted for major medical and how much is maintenance or "well coverage".  If more than $200 per year in premiums for me are for PCP visits, it would be better off to pay $100 out of pocket for each visit considering I usually only go once per year.  Or perhaps the doctor would simply take $70 cash from me instead of marking up the rate to everyone to account for the lower rates the HMO's & PPO's negotiate for their members.  To me they are more like a buyers discount club than an insurance plan.

Health Insurance vs. Health Care is the difference.  My father generally had insurance to cover the big stuff and planned to pay for routine issues out of his pocket.  That was when it was possible to go to the Doctor's office without taking out a 2nd mortgage on the house.  Artist made a comparison to car insurance.   BMW offers "free" maintenance for 3 years or 36,000 miles (or similar) when you buy a new car.  You can be sure the price of that maintenance is included in the price of the car.  There are also limits.  I don't believe you can get your oil and filter changed earlier or more often than the oil change monitor in the car allows.  I don't know the fine print though.  My BMW is getting pretty old now (1995 Model).   Pre-existing conditions is like (trying) buying collision insurance after you've had a wreck to fix that wreck as well as any in the future.  Good Luck on that one with your car.  If we are going to have a Health Care system, then requiring companies to accept pre-existing conditions makes sense.

I get detailed billing info for my medical costs from the insurance company.  It's amazing how much the prices are negotiated down.

One of the insurance options where I work is a large deductible policy.  My employer provides a "bucket of money" to take care of normal expenses.  Depending on how healthy you are, it may cover your expenses.  After that, it's 100% out of my pocket until the deductible is met.  Then there is a split between me and the insurance up to the annual maximum out of pocket level.  Then the insurance covers all the cost.  When I go to the doctor, there is no co-pay.  The negotiated price comes 100% out of the "bucket of money" or my pocket until the deductible is met.   My employer also offers a more standard insurance policy with co-pays etc but the employee's share of the premium is higher.   Which policy is better for someone will depend on their own conditions.

[Hoss]

I thought this photo summed it up nicely regarding yesterday:



I'm not a big fan of Pelosi either, but that sourpuss Boner sure lived up to his moniker here.

[guido911]

And here comes the attack ads:

As I said, let's see how this plays out. But still:

[DolfanBob]

How much more clear can he make it?
Has he come out to say they used the wrong word yet?
It was supposed to be a different three letter word.