Health Care Reform in the US

[I_luv_saber]

Because government stepping out of the mix is not going to stop insurance companies continuing the shady practices that they are now doing, and I have no reason to believe they are suddenly going to see the light and stop it without "encouragement".

EDIT: Note that I don't think insurance companies' business practices are the only problem right now, but I think it's a big, BIG problem.

[Capt. Slo-mo]

Based on the treatment I had for my brain surgery, I think healthcare in this country is pretty darn good.

Gb: It's great that you had a good outcome with your healthcare. But put yourself in the place of many other Americans: Let's say shortly before your first medical intervention for your brain issue, an interprising young adjustor from your insurance company discovers that you made a passing reference to headaches 5 years ago to your doctor, but did not disclose it on your insurance application. All of a sudden, you now have no coverage for all the medical procedures you just went through.

How would you now feel about the healthcare in the country?

Or what if your employer, looking at the giant premium increases headed his way because of your massive use of the insurance plan, decides to no longer offer insurance to anyone? And now, because of your pre-exisiting health issues, no insurance company will touch you at any price.

How would you feel then about the healthcare in this country?

[jeff]

(snip) From some of the methodological articles I have read, both private and public numbers would appear to be far too low. The <21% numbers that keep getting thrown around seemed to be based on the delta between health care premiums and health care payouts without taking into account reciprocal costs incurred by health care providers. (snip)

Yes, that's right - the cost/overhead figures are those pertaining to the insurer (and your description of the Kaiser Foundation is also accurate) and does not include the additional costs on the provider side for issuing claims.

Having been present at any number of meetings on this topic I can't say that I've ever seen any evidence that making claims to Medicare was more costly than to private insurers. Both have lots of paper work, and in fact the private ones follow Medicare standards fairly closely (eg: coding standards). The only significant difference - and I admit that my experience is anecdotal - is that providers have to expend more time and money forcing the HMOs to pay up. The expression I've heard is that "you have to hire a barracuda" to keep after the HMOs or they'll stonewall on payments indefinitely. In short - it seems that Medicare is no more expensive, and apparently less expensive and arduous to deal with.

To your points about investigations - I believe both private and public have internal organizations for fraud detection, and turn cases over to DOJ if there is evidence of a criminal situation. Beyond that I couldn't say.

[Bayou Bum]

Gb: It's great that you had a good outcome with your healthcare. But put yourself in the place of many other Americans: Let's say shortly before your first medical intervention for your brain issue, an interprising young adjustor from your insurance company discovers that you made a passing reference to headaches 5 years ago to your doctor, but did not disclose it on your insurance application. All of a sudden, you now have no coverage for all the medical procedures you just went through.

How would you now feel about the healthcare in the country?

Or what if your employer, looking at the giant premium increases headed his way because of your massive use of the insurance plan, decides to no longer offer insurance to anyone? And now, because of your pre-exisiting health issues, no insurance company will touch you at any price.

How would you feel then about the healthcare in this country?

None of what you listed has any impact on his health care, just how it is paid for. You keep using the problems with health insurance companies to trash health care. It's like saying that by changing who pays for your health care is going to make everyone magically live longer.

[jessicasimpson]

None of what you listed has any impact on his health care, just how it is paid for. You keep using the problems with health insurance companies to trash health care. It's like saying that by changing who pays for your health care is going to make everyone magically live longer.

if in changing who pays for healthcare gives access to healthcare for people who could not afford it, they can live longer, it is not majic. And you wonder why liberals call you dumb?

[tchwojko]

Snowe votes "Yes" in committee. What is she getting out of it? (I don't have a problem with political dealmaking, I just wonder what the deal was.)

[lindajdunn]

http://www.consumersunion.org/pub/co...re/015137.html

YONKERS, N.Y. – As the health care debate continues in Washington, Consumers Union, the nonprofit publisher of Consumer Reports magazine, today released a national poll that says 51 percent of Americans have been confronted with tough health choices in the past year, such as putting off a doctor visit, not being able to afford medical bills or medication, or declining a medical test because of cost.

The national telephone poll of 1,002 adults was conducted September 17-20, 2009, by the Consumer Reports National Research Center. The margin of error is +/- 3.2% points at a 95 percent confidence level.

[keith]

Snowe votes "Yes" in committee. What is she getting out of it? (I don't have a problem with political dealmaking, I just wonder what the deal was.)

Aside from the regular home state benefits? Survival perhaps?

She is one of the few Republican senators not looking over their right shoulder.

[Hauptman]

Aside from the regular home state benefits? Survival perhaps?

She is one of the few Republican senators not looking over their right shoulder.

She's one of the few moderate Republicans left.

[I_luv_saber]

None of what you listed has any impact on his health care, just how it is paid for. You keep using the problems with health insurance companies to trash health care. It's like saying that by changing who pays for your health care is going to make everyone magically live longer.

Why does it matter that we have the best health care in the world if nobody can access it? At least not without spiraling into financial ruin...

You really don't see a problem here? You don't see a problem with the fact that middle class families go bankrupt paying for health care? Especially when in many other countries this would not have happened?

Don't get me wrong - I very much like the idea of letting the private sector handle things. I think it has the ability to handle things more efficiently. So much to the point that I've argued in favor of a voucher system or something similar (at times) as an alternative to public schools, with public schools filling the sort of role Medicare or Medi-Cal (CA program) does now.

But it is simply folly to think that in a situation where the market is naturally skewed in favor of private companies (i.e., they have the consumer by the balls), that we should not have regulations and checks in place to ensure fair play (especially in situations where said company is providing goods or services that are needed for the basic well-being and functioning of society). This is nothing new. In fact, this is commonplace. Why everyone has chosen this particular hill to die on, I don't understand. Where were the huge outcries when we started on additional regulations and attempted to level the playing field with credit card companies?

Evidence has been put forth that preventative medicine and wide access to basic health care ends up 1) Being less expensive and 2) Increasing the health care of the general populace. Our current system does not support this. Our current system is so expensive that it actually encourages people to simply not even get basic conditions treated, much less actually go in for regular check-ups.

[Bayou Bum]

Evidence has been put forth that preventative medicine and wide access to basic health care ends up 1) Being less expensive and 2) Increasing the health care of the general populace. Our current system does not support this. Our current system is so expensive that it actually encourages people to simply not even get basic conditions treated, much less actually go in for regular check-ups.

We mostly agree on the problem of insurance companies, but congress should address fixing the problems obtaining health insurance without the government trying to make health care a function of the government. Look at some of the Republican plans for good examples of how to fix the problem without government control.

While there are also studies that show preventive medicine doesn't lower costs or increase health, I agree with you that it is important. The AMA recommends physicals every one to five years, regular cholesterol tests, colon exams over 40, and cancer screening for women over 30. The problem is not the cost of these procedures, but the fact that people won't seek preventive care unless someone else pays for it, and many won't even then. Should the government require everyone to get preventive care? Preventive care is readily available and not that expensive compared to the many luxuries people choose to spend their money on. If it is a priority, almost everyone can afford all of those procedures.

[lindajdunn]

Kaiser Permanente CEO:

HALVORSEN: …. Right now, when you look at diabetes, 32 percent of the cost of Medicare is diabetes. It’s the number one cost of blindness, it’s the number one cause of amputations, it’s the number one cause of kidney failures. And when you look at the care delivery patterns in America, we only get care right for diabetics 8 percent of the time. If we got care right for diabetics 80 percent of the time, we’d cut the number of kidney failures in half.

American Diabetes Association (ADA)

The total annual economic cost of diabetes in 2007 was estimated to be $174 billion. Medical expenditures totaled $116 billion and were comprised of $27 billion for diabetes care, $58 billion for chronic diabetes-related complications, and $31 billion for excess general medical costs.

While some preventive health care options are not cost effective, others are and to lump them all together and state that preventive health care is not cost-effective is (imho) disingenious. I note that I'm attributing this disinguinity to those who compile these general reports, not to those who read them and/or quote them.

I suggest it might be wise to review which preventive measures are most beneficial and implement those.

[jessicasimpson]

So much to the point that I've argued in favor of a voucher system or something similar (at times) as an alternative to public schools.

Threadjack,
I do not see vouchers as anything but a profit bump for private schools. All the private schools pick and choose who they let in, I do not see them letting in any more poor/middleclass students just because of vouchers. they will let in the chidren of people that can make donations like they always have. I am not trying to trap anyone, but I don't see how vouchers would increase competition

[keith]

Threadjack,
I do not see vouchers as anything but a profit bump for private schools. All the private schools pick and choose who they let in, I do not see them letting in any more poor/middleclass students just because of vouchers. they will let in the chidren of people that can make donations like they always have. I am not trying to trap anyone, but I don't see how vouchers would increase competition

On the threadjack.

In the UK they shifted, quite a while ago, from fixed catchment areas for schools to a parental choice model. All that happens is that the schools viewed as good (by and large those with a predictably upper middle class parental body) get oversubscribed. Those oversubscribed schools then dump problem students into undersubscribed schools.

Note that over and under subscribed are used since school popularity generally has nothing to do with the quality of the education provided.

[dcmdale]

and I admit that my experience is anecdotal

Your anecdotal evidence likely trumps my pure speculation in this regard.

Yes, that's right - the cost/overhead figures are those pertaining to the insurer (and your description of the Kaiser Foundation is also accurate) and does not include the additional costs on the provider side for issuing claims.

Having been present at any number of meetings on this topic I can't say that I've ever seen any evidence that making claims to Medicare was more costly than to private insurers. Both have lots of paper work, and in fact the private ones follow Medicare standards fairly closely (eg: coding standards). The only significant difference - and I admit that my experience is anecdotal - is that providers have to expend more time and money forcing the HMOs to pay up. ...

The main reason that I questioned the numbers is just that I know that because of different accounting standards and funding mechanisms comparing efficiencies between governmental entities and private business is not particularly straightforward. It can be done, but it takes care to ensure that there is a legitimate comparison.

So I am assuming that if the measure of "overhead" for private for-profit insurance is "premiums minus payouts" that profit is being included in the definition of "overhead."

If that is true, I would completely accept the inclusion of profits if we are talking about the ability of private for-profit insurance to provide cost-effective health care solutions. I would separate this from the question of whether they are more or less efficient in actual operations where I would expect the numbers to be much closer.

The goal of a for-profit insurance company, like any other company in America, is to make as much money as possible. That means that their goal is to maximize the overall difference between what they collect in premiums and the sum of the payouts on insurance and operational costs. By law, this is pretty much what they are expected to do.

In this situation, that puts them as much at odds with national interests as if say Boeing wanted to outsource fighter production to China.

Retaining the level of profits that insurance companies want to maintain requires them to maintain a healthy, widespread consumer fear of being uninsured. If the fear associated with being uninsured is reduced because either medical costs become more reasonable or there are other options for paying for medical care, then the perceived value of their product will be reduced which will reduce their opportunity to profit from it.

This isn't to say that the fundamental concept of insurance as a risk-sharing fund is flawed. The idea is excellent. However, it needs to be recognized that the industry (as with all American industry) has goals that sometimes align with the public good and sometimes do not.

The insurance industry profits when:

• The price of medical care to the uninsured goes up. That is, if an uninsured person has to pay $2K for something that the insurance company only needs to pay $1K for--Bingo.
• There is a sense of privilege associated with having insurance. By making sure that there is a class that is excluded, they can charge extra money (unrelated to their costs) for becoming included.
• The cost of medical care generally exceeds the ability of people to self-insure. While they don't want costs too high (because that would influence their payouts, they *need* medical care to be quite expensive.
• They can eliminate customers who will cost them money. As soon as the cost of servicing a customer exceeds their premiums, it is profitable for the insurance company to dump them as soon as possible without jeopardizing the perception of other customers that they are getting something for their money.
• They can enter into privately negotiated differential pricing that permits them to charge higher rates to the poor than to the relatively rich. Big companies have more negotiating power; therefore, can drive a harder bargain. Smaller companies and individuals have to pay more.
• More, but lunch is over.

Note: these are features, not bugs.

None of these examples of insurance company self-interest coincide with national interests. That doesn't mean that I am demanding that for-profit insurance companies disgorge their profits or to lock up all of the executives, but rather that as the national discussion goes forward, it happen with eyes wide open.

[dcmdale]

Threadjack ...

There is a Voucher thread where a lot of this has already been discussed ad nausium.

[I_luv_saber]

Threadjack,
I do not see vouchers as anything but a profit bump for private schools. {snip}

Well, I really don't want to delve too deeply into this. I simply made the comment offhand to note that I'm reasonably consistent in my desire for things to remain in direct control of the private industry, but with government oversight and regulation.

So very briefly: Consistent with the "private but regulated" stance, I would support most schools staying private, but with additional government regulation and oversight, far more than now. If I recall correctly, we've gone into this before in some detail...

[keith]

There is a Voucher thread where a lot of this has already been discussed ad nausium.

Thing is, it is fundamentally the same discussion.

[Philistine]

{snip}
The main reason that I questioned the numbers is just that I know that because of different accounting standards and funding mechanisms comparing efficiencies between governmental entities and private business is not particularly straightforward. It can be done, but it takes care to ensure that there is a legitimate comparison.

So I am assuming that if the measure of "overhead" for private for-profit insurance is "premiums minus payouts" that profit is being included in the definition of "overhead."

It can be hard to compare "overhead" between Government and private companies--but it can't just be premiums-payouts.

Generally, insurance accounting (at least on the non-governmental side) is very tightly regulated. Insurers generally file their audited financial statements with the Insurance Departments of their states, and those states do regular financial examinations.

Here, for example is the list of financial examinations (not just health insureres) from the Pennsylvania Department of Insurance (IIRC, they generally do them every 5 years).

Here is Independence Blue Cross's report--it's a very large health insurer doing business primarily in the southeast part of Pa (including Philly).

The numbers are interesting--about $360 million in premiums, $321 million in payouts (including reinsurance payouts); but a net underwriting loss of $11 million caused, primarily by "claims adjustment expenses" of $11 million and "general administrative expenses" of ~ $39 million.

Personally, those two--$50 million--are what I've always understood overhead to be.

They also posted an investment income of about $39 million.

Part of the reason private insurance companies have high investment income is that they are required to have very significant assets available should there be catastrophic losses.

I don't know how medicare and other government programs are regulated, as to reserves, though I suspect that being backed up by the Government, they don't have the same requirements, and thus have a much smaller surplus, and so not a whole lot of investment income--but that's just a guess.

--Philistine

[jeff]

She's one of the few moderate Republicans left.

GOP Claims Olympia Snowe Was Born in Kenya
Birthers Demand Proof of Non-Kenyan Status

WASHINGTON (The Borowitz Report) - Just moments after she broke with fellow Republicans and voted in favor of health care reform, Sen. Olympia Snowe (R-ME) came under fire from the GOP for allegedly lying about her nation of birth.

"This vote is going to raise suspicions, once again, that Sen. Snowe was born in Kenya," said GOP Chairman Michael Steele. "We demand that she prove, once and for all, that she is definitely not Kenyan."

Orly Taitz, leader of the so-called "birther" movement, said that Sen. Snowe's vote was "textbook Kenyan" behavior: "She's putting her tribe first."

In other news, conservative radio host Rush Limbaugh said he would acquire the St. Louis Rams and rename their stadium The House of Painkillers. Limbaugh's move came after a failed bid to acquire Minnesota's NFL franchise and rename it the Minnesota Vicodins.

Elsewhere, the Rev. Moon married 10,000 people, putting him slightly ahead of Liza Minnelli.