Healthcare/Health Insurance: what is the actual problem?

I have a nephew that is a newly minted doctor. He says the specialty that attracted the best and brightest among his classmates was dermatology. Lower academic performers, but still incredibly bright young folks, are stuck with neurology, oncology, etc.

 

I hate to break this to you but expecting things to simply return to the way they were is fantasy. That means ~32M losing health insurance. It means no protection for pre-existing conditions. It means no parental coverage for children over 21, a period in which no young adult can afford coverage. Nor will health care prices suddenly lower. They were escalating pre-ACA and will do so afterwards.

Can we agree on these items? If so, we can start the negotiation from there.

I'm a veteran and have experience with the VA. Those claiming it as an example of "single-payer" healthcare are simply displaying their ignorance for all to see. It's an example of military healthcare which is typically substandard. Never would I have a military dentist touch my teeth. Why? The quality of the person dentist/doctor that would rely on the military to pay for their college or enter the military after medical school is less than average based on my limited experience. That's not to demean some good doctors but overall that's my experience.

As Crockett mentioned, Medicare is a much better example of a single-payer system in the US that is moderately successful. Right now it covers 23% of all US citizens.

 

Not at all. I know enough to know that I don't know the answers. I'm just saying what I see as to how we got there. I mean, just looking at the change of the small town docs that I've known in my 50 years. My family doctor was a local mentor/friend to my dad. He lived less flamboyantly than did many others in town - pharmacists, attorneys, funeral home owners, etc. Not surprisingly, said small town is having difficulties getting a doctor to replace the docs that are in their 70's.

 

No, we aren't going to agree. I don't see the need to have ADULT children being covered by parental policies. Costs continued to escalate because people insisted on coverages being 'mandatory' that were irrelevant. Policies for actual INSURANCE were affordable before Obummer. While they may have been escalating, as a SWF who was under 45, I still had insurance that provided what *I* needed it to do and that was costing me under $200 a month. With the advent Obummercare, I lost that policy...the plan didn't cover all the crap Obummer insisted policies provide for. By the time he backed off of some of that requirement, plans were already gone and premiums had skyrocketed. As such, it became cheaper for me to self-insure. Thankfully Trump allowed us to not have to check the box this year...saves me from having paid the fine, err 'tax' for not having government-approved coverage.

The problems began creeping in when we began molly-coddling the little cretins who claimed they needed a year or two to sort their life after their already six years of college instead of getting their asses into the workplace to, oh...earn a living instead of leaching off of mommy and daddy.

I don't believe policy holders should have to see THEIR premiums increase because the government tells the company they HAVE to insure pre-existing conditions. That is a risk factor that should be borne by those afflicted. It is no different than being a driver that has to pay higher premiums for being a new driver...higher risk, higher premium. It's about that simple. Stick around with the company and premiums come back to earth once they can see where their risk actually centers at for that driver.

Oh, and my VA comments come from listening to my managing partner was is also a retired Colonel and was JAG prior to entering private practice. The fiasco he had to go through at the beginning of the year when they botched some sort of policy change and left him without coverage for a period of a few weeks was nothing short of comical...except, it really wasn't funny. It was another sad shitshow of government ineptitude. I don't hear much better about medicaid...

 

I tore up my elbow when in college to the point of near amputation. I didn't have insurance. While paying 100% of my own bills through college health insurance was the last thing on my mind. Because I didn't have health insurance the State of WA and UW Medical Center picked up nearly 100% of my surgeries (3) and 6 months of rehab. I was fortunate. My eldest son will be heading off to college in 3 weeks. Why not include him on my insurance to ensure he has insurance. That helps society and literally didn't drive any of the increases in your insurance costs.

Cost were escalating by 15-20% annually before the ACA. If there was a giant miss in the ACA from my perspective it's that they didn't do anything to control the cost escalation. Clearly you had a policy that worked for you. Maybe because you didn't need maternity services or some other item that became a minimum health insurance policy. Many insurance policies being sold at the time were garbage. Not saying yours was but some were.

The difference now between when we (I'm in my 40's) went to school and the kids today is the cost. In state public schools are no ~$30k/yr and private schools ~$65k all in. The debt the kids take on limits their options of living on their own after college. These kids don't have a lot of control over that. It's also VERY common to go right from Bachelor to the Masters. That latter is required for the better jobs for kids without the job experience. You may call a kid moving back home as molly-coddling, I'd call it economically smart to get on their student loans paid down before taking on rent/car etc. As a parent, it's one thing I can offer to help them get into their life and into their home ownership quicker. Perspective, huh?

Here is the difference, auto-insurers can simply refuse to insure a high risk driver. No insurance means they can't drive. A former cancer patient with high likelyhood of recurrence doesn't have a choice in whether they'll have healthcare or not. There is no "bus" option for healthcare. My sister-in-law was diagnosed with Leukemia at age 35. It's treatable but she'll have to take medicine the rest of her life. The medication is $1k - $2k/month. Clearly her insurance should cost more than mine and does. There is no rule that says pre-existing conditions MUST be the same cost as your insurance only that they have to cover them. You and I are subsedizing the 20%+ that have pre-existing conditions. It's not fair that you have to pay more but I think it's the moral thing. Life sucks that you are impacted.

Your managing partner clearly knows to try to stay away from all military doctors. If he's chosen to leverage VA coverage then he's making a cost decision over quality. I don't buy a Hyundai and expect it to drive like a BMW. Rather, I choose to pay for the BMW because quality is more important to me.

 

This story is really eye-opening in regards to the health care debate going on our country today.

I don't care what the circumstances are around the baby, the state has no business blocking the parents' wishes to obtain willing 'legal and expert' professional care on their own dime.

And some want the state fully in charge of our health care...

Judge Says Charlie Gard Can't Go To The United States

Despite their son being granted permanent residency in the United States, a judge is prohibiting Charlie Gard's parents from transporting their son to the U.S. without a court order. Next week, a judge will issue a decision on whether or not Charlie will be permitted to travel to the United States at all. The judge's decision will hinge on whether or not there is "new material" that could change his mind.

Charlie's parents, Connie Yates and Chris Gard, raised over $1 million to pay for their son to travel to the U.S. for an experimental treatment, but the European Court of Human Rights ruled that it was not in Charlie’s best interest to travel to the United States. Other hospitals in Europe have stepped up and offered to care for Charlie, but those transfer requests have been denied as well.

 

This is an all too common occurrence with Trump. Last week he claimed that college students could get health insurance for $12 per year. He's made that statement at least 3 times over the last 6 months. Now this:
[/MEDIA]

 

Schumer and Dems unveiled the party's new 'a better deal" platform this week.

Careful before you sign that deal folks, he openly admits (1:41 mark on vid below) single payer is the Dem's answer for your healthcare.

VA, IRS, student loan scam, Obamaphone fraud, pay for play, intolerant academia, etc. Might want to keep these corrupt scumbags from controlling your healthcare.

Schumer: Let's Drop The Fiction That Single-Payer Is Not On The Table; It's On The Table

 

Looks like the repeal efforts are dead and that we're headed for either implosion or a compromise effort with Democrats. I should be bugged by this, but I'm not. Was anyone really excited about the GOP bill or think it would have made a major positive impact? I saw minor improvements but nothing transformational one way or the other. It's a significant political loss, but it's not a significant policy loss.

It seems to me that the core problem is that the large numbers of Republican voters in key states simply don't want a free market system. They want Medicaid protected and want onerous federal mandates on insurance carriers. (In other words, they want Obamacare or some variant on it, even if they're critical of Obamacare.)

I'll go back to what I've said before. We're going to have single payer or something comparable to it (a public option, etc.). I don't want that, but it's gonna happen.

 

Yup, Murkowshi, Collins, and McCain voted with the Dems to doom the "skinny repeal" bill.

McCain is hard to figure. They say he campaigned against Obamacare in the last election.

McCain reportedly mumbled something like; "they passed Obamacare without a single Republican vote. we shouldn't do the same thing".

 

Hogwash. 32 million people will not lose health insurance. They might not choose to buy insurance, but they are not "losing" anything. I do agree with you that the ship has sailed, like all other liberal giveaways. Too politically tough to take away freebies.

 

McCain is a politician of the worst ilk. All three of those should have joined the Democratic Party a long time ago. They can take Alexander, Graham and a few other liars with them.

 

Exactly.
Biden was sooo correct "this is a big f****ing deal", but I doubt he even knew just how big. Make way for 'Momma' Sam, Uncle Sam is gone.

 

Democrats may be incorrigible but Pubs are incompetent buffoons. Sick of them all.

 

7 years and they couldn't come up with anything. I bet a plan that didn't offer huge tax breaks to the top tier might have had a better CBO score. I don't guess we'll ever know.

 

No kidding, but I know the narrative is big tax breaks from Dems, but I think it is more about personal gain. Except for McCain, who cares more about his long time buddies and his legacy in the senate.

 

Narrative or fact? http://www.taxpolicycenter.org/taxv...h-bill-big-tax-cut-especially-top-one-percent

"...nearly 45 percent of the benefit of those tax cuts would go to the highest-income one percent of households, those making $875,000 or more."

I know I moved the decibel a few places a while back but Warren Buffet was set to gain $680,000 from the House version. And, if this skinny repeal had passed they'd have gone into conference and they would have come out with a merged bill that served that purpose.

 

Congress still has ample opportunity to help health care consumers and stifle inflationary pressures in the system. Low hanging fruit includes price transparency, tougher negotiations with pharmaceutical companies and promotion of voluntary but incentivized end-of life care focused on dignity and quality of life rather than revenue maximization.

 

The thing that we have to get to is the real world crap I see daily. Many hospitals/docs can do a procedure for the Medicare rate and be happy to do it. But, if someone has no insurance, they are routinely required to pay as much as 5-10 times more for the same procedure/hospitalization. Crazy.

 

This last "skinny repeal" bill would have resulted in 16M fewer people being insured and 20% annual increases in premiums. Much of that 16M would have been from the removal of the individual mandate since the Medicaid increases remained in place. Of course, it also removed the requirement for large employers to insure their employees. The CBO's assessment likely took all 3 scenarios into consideration when determining the reduction in insured.

Mr. Deez nailed it...the increase in Medicaid coverage for some states was too much to overcome. If it wasn't for McCain to step forward and take the bullet for other Senators like Portman then other Senators would have been #51.

It should be noted that the Trump admin is transparently trying to push Obamacare over the cliff. Their actions via Tom Price and co. are introducing instability into the marketplace. So, even if nothing passes, Trump can and still will own the demise of Obamacare. That doesn't mean that Obamacare doesn't have some fundamental flaws but Trump seems intent in expediting the demise. He owns those actions regardless of what he tweets.

 

I just left a meeting where we examined reimbursement for government cases. The hospital had the highest number of Obamacare enrolled in the country.

Average reimbursement for our clinician was $32 from the government.

Please let me know what procedures you perform as s doctor where you are happy with the Medicare reimbursement.

 

BS. Please provide some evidence.

 

It is really the hardest problem I think we have to tackle. While I don't believe it is a right, I do believe that a society and economy as advanced and capable as ours, with the resources that we have, should be able to construct a healthcare system that enables everyone to have reasonable care that doesn't break the country and doesn't bankrupt the individual if they have an UNFORESEEN event in their life.

I believe there are two things that are paramount in order for this to happen.

1. Price transparency. A doctor/hospital/provider must charge the same price for al customers/patients no matter what their insurance provider or plan is. And the doctor must make these charges available to the public. And the doctor must indicate which are "minimums required", vs. "recommended" aspects of treatment. health care is about as complex a decision as their ever will be in your life, especially when you have to factor in cost. trying to make a cost/reward decision is daunting even on your own life...try making that decision for a child. People are ALWAYS going to sell out the farm, especially when they can't even get a straight answer about what it will costs. "Give me the best you got, doc!!!" If they don't have to bear the financial burden of that decision, the rest of us will. I think this would greatly aid the consumer/patient and probably the doctor/hospital as well, because it would greatly simplify the billing process versus what they have today.

2. We have to change the conversation from health insurance to health plan. The majority of people have come to view health insurance like it is some magic coupon that allows them to take out more than they put in. (and in some cases...much more). Health plan is for routine care and recurring/expected medications, treatments. Health insurance is for unforeseen, unknowable, unforeseeable events. I want to pay $500 a month for "insurance" when I already know that my medications cost $15,000 a year... huhh??? that's no longer "insurance". That's a free ride that someone else is paying for.

We need to incent participation in saving/preparing for your own health care as early and as consistently as possible. For that, I would suggest HSAs that give generous benefits for early and consistent participation. Whatever you put in is tax free to put in/maintain and tax free withdrawal always and forever. Only caveat is that you must pay your non-qualifying health plan expenses out of this account. Give a tax credit multiplier/incentive based on the number of years and number of consecutive years the individual has been contributing to their plan. ie. someone that has paid in for a total of 20 years and 10 years consecutively has a tax credit that is much higher than the person that has paid in for 2 years.

I would also suggest that we decouple health insurance from employment. Creates more transparency for the consumer and I'm sure most businesses would be happy to be free of this financial and administrative burden.


Just one example of what I mean by not an unforeseeable event. I don't consider pregnancy unforeseen. In my world, we wouldn't cover delivery with insurance. That would have to be a HSA type fund. If the pregnancy had unanticipated complications and required extraordinary intervention, that would be an insurance covered event.

 

It takes a panel of experts and incredible patience to even decipher a hospital bill, much less compare what you pay to what insurers and Medicare pay.

https://www.nytimes.com/2017/03/29/...yre-one-reason-health-care-costs-so-much.html

 

Bubba said hospitals can easily make a profit off Medicare rates, so the complication of reading the bills is irrelevant to my post. However, I don't disagree with the link, but Obamacare does absolutely nothing to fix that and actually makes it worse. Did I mention that the $32 often comes 9 months later after multiple appeals?

Now insurance companies often try to move to Medicare rates plus a little. It will bankrupt hospitals and cause a severe shortage of healthcare providers. However, everyone will have insurance documents they can tape over their wounds! Yippee Liberals!

 

No doubt a system built on prices perpetually increasing like energy costs in the 1970s will have some painful shakeouts with any pricing constraints.

 

The only way to fix our escalating cost problem will be a fundamental system restructuring in which there will be winners/losers. Oh, I agree that Obamacare did nothing to address the cost increases but was rather focused on access only.

 

If the losers are hospitals, drug companies, insurance companies and healthcare providers, how do you actually get care beyond personal concierge care?

Like it or not, if there is no profit incentive for healthcare companies, the money will be invested elsewhere. If their is no income incentive for healthcare providers, there will be a shortage of providers.

 

I work as a third party administrator. Air ambulances ROUTINELY bill as much as 8 times the Medicare rate. The company we use is happy to get the the Medicare rate and they make money on on it. Medicare rate with hospitals is cost based. A hospital that writes off uncompensated care or has residency programs will have a higher rate per case than one that doesn't to cover those expenses. Physician owned hospitals' Medicare rate may be 40% less. These are real world #'s off of a DRG that I researched a few months ago. Hospital A: $28,191. Hospital B: $31,1000. Hospital C: $36, 218. Hospital A is a non-profit. B is a publicly traded hospital but closer to downtown and C is a hospital close to downtown but with a residency program. Billed charges could EASILY be well over $100,000. The hospital that our program spends millions with annually is more rural and would likely come in at about $25,000. They're happy to get it and are doing well on that rate. The physician owned hospitals will get something like $20,000 on that same DRG and be happy to get it as they don't take ANY uncompensated care except for the charity care that their physicians direct into the building. They're the purest example of a "single payer" system where everyone has a payer. When everyone has a payer the cost is less.

The Medicare cost report analyzes your expenses and your income and adjusts your rate annually to try to get you up to covering your costs. When you get private insurance you get more than costs. After the cost report you could get a check or you could get your rate adjusted down. It used to typically be a factor of your billed charges. Bill $100,000 and you'd get reimbursed $75,000 but there was no arbiter of what charges should be. When I was in grad school we had a nifty new program called Lotus 1-2-3 and my boss created the chargemaster by multiplying cost times 7. Much like the mother in law on Sixteen Candles opening the danishes....viola! Over the last decade insurers started using a factor of the Medicare rate. 175% of Medicare for example.

Hospitals cover their costs on Medicare. They cover their costs plus profits with private insurance. They lose money when people have no insurance so they have to "cost shift" to try to get something out of the rest.

 

Healthcare is 1/5th of our economy from what I've read. I'm not sure anyone would ever advocate removing all the profit motive. That would never get passed to the influence of the various lobbying orgs. With that said, if we have any intention of controlling or even reducing costs someone is either going to have to be removed entirely from the food chain or at least take a haircut. The US spends more $GDP per individual on healthcare than any other country by a wide margin. Simultaneously complaining about the cost of healthcare while ensuring all the existing players continue to get their cut doesn't make any sense to me.

Personally, I think the opportunity is to remove the insurance providers but drives us to socialize medicine.