"Health care" US style

[olyclimber]

YnHwd3YYx_c

[tvashtarkatena]

Uncle-san, already.

[prole]

 

I wouldn't laugh too hard, KKKY. Your cookie cutter software job can and probably will be outsourced to India or elsewhere with a snap of a manager's finger. Marylou's will never be.

 

That's true, though the stagehands strike on Broadway may be a watershed moment for my trade's working conditions. We'll see.

 

Which is exactly why busting unions and bringing in scabs and non-union immigrants is so important!

[marylou]

Shop around for the cost.

 

Ask, "How much will this cost, and what do I get out of this?"

 

In addition, don't just shop around in the US. See if going overseas to Singapore will benefit you too. I have heard of places like Singapore and Hong Kong that have US trained doctors. After you are done with the surgery, you get a 5 day vacation at the spa where you have the surgery. Find out how much it costs, talk to your insurance company and see if they would be willing to pay for your airfare too.

 

I think you're a little naive about how HMOs operate.

 

They don't pay for you to have surgery in Singapore.

 

I saw my ankle surgeon up at GH today and he practically pooped his pants when I told him I'd be picking up 20% of the cost. They keep docs blisfully out of the loop on the nuts and bolts of things like that.

[JayB]

What happens to life expectancy when you correct for deaths that occur in murders and automobile accidents in each country....

Table: Raw Life Expectancy vs Corrected Life Expectancy

[Left side = raw life expectancy, right side = life expectancy for those that do not die in homicides or car accidents]

 

I can't vouch for the numbers, but I think they're worth considering. Once you correct for mortality in cases in which routine preventive care, or medical care undertaken to treat disease and/or illness, would do little or nothing to affect the outcome - what do the numbers that you end up with tell you about the actual quality of care in each country?

 

If the numbers are correct, how would investments in addressing crime and road safety yield affect longevity in comparison to comparable investments in preventive medicine?

 

 

[ClimbingPanther]

Something tells me the fact that we spend more per capita than any other country is due in large part to our tendency to get medical care for our problems. I'd be willing to bet that a lot of our treatable illnesses & inconveniences go untreated in other countries.

[Crux]

Health Care Excuses - Paul Krugman, NYT Op-Ed, 09 Nov 2007.

[noliquidity]

Preventative medicine is a complete waste of time. It focuses on this obnoxious thing called "quality of life". We need to focus on longevity regardless of any potentially preventable chronic illness.

 

I am going to look for the stats on that..............

 

 

 

 

 

"Remember kids..........Its about quantity not quality!!

[KaskadskyjKozak]

Preventative medicine is a complete waste of time. It focuses on this obnoxious thing called "quality of life". We need to focus on longevity regardless of any potentially preventable chronic illness.

 

Americans aren't interested in quality of life, or we wouldn't have so many fat fuck fast-food junkies.

[iluka]

Something tells me the fact that we spend more per capita than any other country is due in large part to our tendency to get medical care for our problems. I'd be willing to bet that a lot of our treatable illnesses & inconveniences go untreated in other countries.

 

There is some element of truth to this but a large part of the extra expenses in our system are related to the huge administrative costs involved in running it. Administrative costs in the U.S. are something like 300 times as much as in other industrialized countries and these costs get passed onto the consumers.

 

Why the administrative costs? This is largely due to the problems tracking down payments from the insurance companies and the government. The UW medical center, for example, has several hundred full-time employees working in the billing department whose main roles are to ensure compliance with medicare billing practices so the government will reimburse (albeit not very well) for the services provided and to track down payments from insurance companies. Insurance companies, for example, reject a certain percentage of claims up front regardless of their merit. They do this because they know many providers and physician's offices will not put in the effort to resubmit the claims or argue on their behalf. Dealing with such problems takes time and people and.... costs lots of money.

 

I heard a talk a few years back from a leading proponent of national health care who related an experience he had when he visited a public hospital in Canada that is part of their national system. Their billing department... 3 people... whose role was largely to track down payments from Americans treated at that hospital. The billing department at his hospital in Boston... 300 people. You do the math.

[JayB]

The administrative-cost-analysis may still come out in favor of single-payer systems if you account for the costs associated with raising the revenue via taxation in the same manner that you account for raising revenue via billing, but if intention is to compare costs accurately this is one of a few points that should be taken into account.

 

It doesn't necessarily follow that if administrative costs are high, the only way to reduce them is via nationalizing every private component of the health-care system.

[tvashtarkatena]

The current system is a maze of many insurers and many health care providers. A single payer system would create a single insurer and many (still private) health care providers. That should remove a great deal of administrative complexity and therefore overhead from the system.

 

In addition, a single insurer would amortize the costs of more expensive procedures over the largest number of those covered, and maximize the bargaining power of the insurer.

 

Theoretically speaking, of course. Even the simplest system can be screwed up in implementation.

[dmuja]

 

It doesn't necessarily follow that if administrative costs are high, the only way to reduce them is via nationalizing every private component of the health-care system.

 

According to these guys Solution

 

"Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans."

 

So you like the idea of reducing the costs of a bureaucracy JayB, just not the idea of those savings going to those who are supposed to be the beneficiaries of a "health care" system - namely, the patients?

 

You must have had a rough childhood

Edited November 13, 2007 by dmuja

[Crux]

Silly man. Everybody knows a ship sailed across the ocean is but a vessel to kill the crew as it plunges over the ends of the earth. Plans to launch a fleet and establish trade routes are ludicrous. It seems utterly plausible that arguments comprising claims that every other wealthy country now enjoys some nebulous gathered advantage by such fantastic venture are but wishful defiance of the sensible and Friedman, as evidenced by Birkenstocks and polite baristas.

[JayB]

 

It doesn't necessarily follow that if administrative costs are high, the only way to reduce them is via nationalizing every private component of the health-care system.

 

According to these guys Solution

 

"Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans."

 

So you like the idea of reducing the costs of a bureaucracy JayB, just not the idea of those savings going to those who are supposed to be the beneficiaries of a "health care" system - namely, the patients?

 

You must have had a rough childhood

 

If insurers are competing for market share, particularly in a marketplace that's not composed of a mishmash of state-specific fiefdoms, are you suggesting that insurers that realize gains in efficiency will have no incentive to use the said gains to capture more market share by providing identical coverage for a lower price?

 

 

 

 

[JayB]

 

It doesn't necessarily follow that if administrative costs are high, the only way to reduce them is via nationalizing every private component of the health-care system.

 

According to these guys Solution

 

"Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans."

 

So you like the idea of reducing the costs of a bureaucracy JayB, just not the idea of those savings going to those who are supposed to be the beneficiaries of a "health care" system - namely, the patients?

 

You must have had a rough childhood

 

 

http://www.simplecare.com/about.html

 

http://www.aafp.org/fpm/20060200/642500.html

 

 

[chucK]

If insurers are competing for market share, particularly in a marketplace that's not composed of a mishmash of state-specific fiefdoms, are you suggesting that insurers that realize gains in efficiency will have no incentive to use the said gains to capture more market share by providing identical coverage for a lower price?

 

Do you live in the real world, or even read the previous posts in the queu? Insurers gain by inefficiency in terms of paying claims. There is no free-market advantage in the current system for insurers to increase efficiency in their claims-paying dept. Customers (the ones who buy the insurance) do not see much of the struggles of the medical offices trying to collect.

 

Also, as a rate-payer, if you do have a problem with your insurer it is not easy to switch to another plan and see if it works better for you, due to existing conditions clauses. Even if you work in a large employer with a multitude of different plans, you are only allowed to switch once per year.

 

Face it JayB, the pressures that are usually at work the keep the free market efficient are not there in the current medical services compensation system we got here. Your standard boilerplate don't cut it in this scenario.

 

If there were some ways we could apply more free-market pressures to our current system, I'd be all for hearing that. Perhaps some "donut" type thing like goes on with the new medicare prescription plan, where a single-payer plan covers basic preventive care (cheap) and catastrophic low-probability high-expense stuff, then let everyone fend for themselves in terms of the middle stuff, either by self-pay or private insurance?

 

Also, it would be good to have some governmental regulations that require medical offices to make their prices easily available to the choosy consumer. The way it is now, you have no idea how much anything is going to cost until you're right there getting told you need a surgery and you've told them you don't have insurance.

[tvashtarkatena]

Face it JayB, the pressures that are usually at work the keep the free market efficient are not there in the current medical services compensation system we got here. Your standard boilerplate don't cut it in this scenario.

 

I couldn't agree more with this statement. The kind of free market model JayB's talking about requires two things: easily definable goods and services, and fluid, open information. The health care market has neither. The system is so complex that the administering companies can't even negotiate it, nevermind a consumer. We regularly get bills we don't owe, and mysterious refunds from our insurer. It's not just difficult for consumers, including companies, to compare costs...it's impossible. Furthermore, the very nature of providing health care to humans means in an infinity of complications and unknowns. Not only are there almost an unlimited array of goods and services involved, but those services can quickly expand when complications, which are never very predictable, happen.

 

[Stefan]

I think you're a little naive about how HMOs operate.

 

They don't pay for you to have surgery in Singapore.

 

Have you ever asked?

 

 

[JayB]

If you click on the links that I provided above, you'll see the beginnings of a different model which eliminates insurers and the inefficiencies that they represent from the provision of routine medical care.

 

It should be easy to see how such a model would work in conjunction with high-deductible plans coupled with health-savings accounts, especially those that permit the accumulation of assets in the said HSA's, with the cost of the policies offset by tax incentives that accrue to individuals, rather than employers.

 

I don't think that it's inconceivable that you could structure the catastrophic plans in such a way that you encourage people to make prudent choices about their care, such as increasing premiums for those who don't get routine physicals, screenings, etc.

 

For those who can't afford care, giving them access to a fixed dollar amount of money to spend on routine care every-year, that could only be used at clinics, hospitals, and pharmacies, and refunding them a portion of the balance that they don't spend* in cash provided they get the necessary checkups, etc - in conjunction with a gap that they have to cover themselves before the state kicks in the money for the amounts that exceed the balance is at least worth considering. Instead of giving doctors an incentive to refuse care to people who are on medicaid because they lose money every time they see a medicaid patient, they'd have an incentive to compete for their business, and medicaid patients would have more control over who they got their care from.

 

*The "rebate" could be placed into a HSA that they could apply towards the "donut hole." in their coverage.

 

For people who can't reasonably be expected to be responsible for their own care or the care of their dependents, it doesn't seem like there's many options other than letting the state assume full responsibility - both in terms of paying for and directing - their care.

 

This would have elements of a single payer system in that the state would be paying out quite a bit of money for medical care, but at least when it came to routine care - neither a public nor a private bureaucracy would come into play.

 

 

[ClimbingPanther]

Just vote Hillary in 2008, she will fix everything. Like she fixes her audiences.

 

Quotabe quotes:

 

"This is not standard policy and will not be repeated again."

 

-Clinton's campaign spokesperson, upon being asked about the planting of questions in a speech audience.

 

My question is how the heck did she keep it under the radar for so long?

[JayB]

Face it JayB, the pressures that are usually at work the keep the free market efficient are not there in the current medical services compensation system we got here. Your standard boilerplate don't cut it in this scenario.

 

I couldn't agree more with this statement. The kind of free market model JayB's talking about requires two things: easily definable goods and services, and fluid, open information. The health care market has neither. The system is so complex that the administering companies can't even negotiate it, nevermind a consumer. We regularly get bills we don't owe, and mysterious refunds from our insurer. It's not just difficult for consumers, including companies, to compare costs...it's impossible. Furthermore, the very nature of providing health care to humans means in an infinity of complications and unknowns. Not only are there almost an unlimited array of goods and services involved, but those services can quickly expand when complications, which are never very predictable, happen.

 

I agree. The current system has neither. I don't think that you can make this argument about all systems other than a single payer system that's centrally administered by the state.

 

Take a moment and look at the links I posted above for an example of an alternate model.

 

If our plan comes together, my wife and I will be taking some time off from work this summer - might be several months - and this is the approach that we're going to use. High deductible catastrophic coverage, and cash-only providers for routine care. Tax credits and a HSA would be nice, but the advantages of this approach over paying hundreds of dollars a month for comprehensive coverage are incentive enough to make the switch.

[KaskadskyjKozak]

Do you live in the real world, or even read the previous posts in the queu? Insurers gain by inefficiency in terms of paying claims. There is no free-market advantage in the current system for insurers to increase efficiency in their claims-paying dept.

 

Do you live in the real world? There is no advantage for a government-run-monopoly "single payer system" to increase efficiency. It will be a massive cluster-f*** like all gov't bureaucracies.

 

[tvashtarkatena]

If our plan comes together, my wife and I will be taking some time off from work this summer - might be several months - and this is the approach that we're going to use. High deductible catastrophic coverage, and cash-only providers for routine care. Tax credits and a HSA would be nice, but the advantages of this approach over paying hundreds of dollars a month for comprehensive coverage are incentive enough to make the switch.

 

Sounds like a reasonable plan for two healthy folks in the short term. I'll look at the links.

[tvashtarkatena]

Well, I couldn't agree more with the pay up front - no collections overhead - reduced rate idea. You still have to have a catastrophic plan, however. The key idea here, to either agree or disagree with, is whether or not to amortize the cost of catastrophic care over a large group of participants, or have everyone pay their own way. Given that any one of us could have a heart attack or get hit by a truck, it seems more sane and humane to amortize. This makes insurance necessary.

 

A single payer system could easily include plans which involve paying a discounted rate up front for routine care, while managing only the catastrophic side. Kind of the best of all worlds, because it provides an incentive for payers to reduce the volume of complexity and uncertainty where it's not needed; routine, predictable care (which is probably most care for most people).

Edited November 13, 2007 by tvashtarkatena