I don't believe gov't should "RUN" healthcare, as much as being a mediator between Insurance, Medical Industry and the people...the costs are way out of control...
It cost me, and my insurance $1800.00 for a 5 minute CT scan...that's amazing to me!($1,800.00 for FIVE MINUTES...)
And when I get a medical bill, it'll say something like; cost = $180.00, insurance "negotiated" cost = $32.00...we can't negotiate or tell a doctor what we will pay, but insurance companies do it all the time. So they are paying less, taking in more...man I'm in the wrong buisness..
They're even influencing Policy...to benefit them, no less...It should be the other way around.

 

There is no "health CARE" mess, there is a health insurance mess. Everybody gets care.

Tort reform and more market oriented practices will fix health insurance. A massive new govt bureaucracy wont. (See Canada for the woes of public insurance).

As long as somebody else is paying for your health costs (employer paid premiums, insuror paid costs) then people aren't going to care what proceedure X costs or pill Y costs. Until then, the costs are going to continue to skyrocket. Govt health insurance that doesn't address these two issues (liability and lack of consumer awareness of the costs) will fail.

People don't realize health insurance was never created with the individual in mind. The first health insurance companies were formed by hospitals as a way of making sure they got paid whether or not a patient could pay. Health insurance protects the PROVIDERS, not the patients.

Same thing with car insurance....there's a reason you don't have to have full coverage after your car is paid off....because nobody but you cares at that point. Most forms of insurance are to protect creditors, not the consumer.

 

I have to agree with you, it seems these days the Big Insurance conglomerates run the world, and health insurance is a run-away train.

I also think, once the "Insurance" problem is dealt with, the prices will drop for health care, as you're saying. Right now they must somewhat, "over charge", just to get what they really NEED to be survive.(after being negociated down)
I was just stating it's difficult, to say the least, to compete with areas/countries where companies pay very little, to nothing, on the massive insurance burden, and their Govt gives them the assist.

 

To expand a bit, there are two huge issues:

1. Medical Liability premiums are outrageous because of frivilous lawsuits. Tort reform is needed to reduce costs that are actually driving many doctors out of practice. When your Med Mal Premiums equal what you're paying yourself, its hard to keep a practice open, pay staff, etc without jacking your prices too the moon, which end up getting borne by the patient's insurance, meaning premiums for health insurance end up going up too.

2. Third party payor system. Nobody actually receiving care gives a crap what the care costs. Therefore there is no incentive to get the best price, etc. Insurance companies aren't big and evil due to this, its just how the system is structured.

Example. If we passed the the Govt Autocare law and every person over 16 in America got a Car courtesy of the government, 3 things would happen. 1. Since you wouldn't ever see or care what the actual cost of the car is, you'd go out and get the nicest car the plan would pay for. Your car "copay" would be $1500 regardless of the cost of the car. 2. When it came time for service, etc., again, you would get the best parts, the best tires, the most expensive mechanics because you want the "best" for your car. 3. The cost of the program would be paid for by all taxpayers. With no incentive to shop around or live within your budget, everybody would be driving really expensive cars and taxes would have to be jacked up to cover the program's outlays.

That's exactly what we have now in health insurance, just not in a 100% government formula. Why do you think Medicare and Medicaid costs keep going up out of control? Nobody cares what the costs are, that's why. Health insurance needs to be totally revolutionized to make 2 things happen: Change the intent from a provider payment concept to actual insurance for the patient, and increase the incentive for individuals to find the best prices.

IMO the best form of insurance would be to have a catastrophic insurance plan for if you get cancer or hit by a car, etc. Then use a medical savings account for doctor visits, dental cleanings, checkups, sick visits, etc. Both could still be employer provided but with this approach you are incentivized to stretch your MSA and price compare. You should get to keep whatever's in your MSA at the end of the year. Right now all we ever see is the $15 copay...who gives a crap how much insurance has to pay, because you're not paying that anyway, right?

Just moving the whole system to government pays vs. private insurance pays solves NOTHING if the two above problems are not fixed. And they can be fixed w/o making it a big new govt program.

I work at a private university. They pay most of our health insurance premiums. For an indivudual you pay $55/mo and the University pays the other $300+ That's $4200/yr. A lot of money could be saved by everyone by splitting that up into a catastrophic plan that would cost maybe 1/3 of that, then put the rest into an MSA. If I only spent $1000 that year on dr visits, etc. I'd get to keep what's left...which is a nice incentive, and the eventual aggregate power of everybody price comparing would bring down insurance costs nationwide.

 

Umm that is an overly simplimatic example at best. You ignore deductibles, Co-insurances, service limitations, and Maximum amounts.

With a Co-insurance you pay a percentage of the allowable amount ie insurance pays 80% you pay 20%. So id DOES matter what the cost is. BTW allowable amounts only apply to in-network, contracted providers. Those outside the network can charge whatever they want. Dedutibles are real and MANY people have them. So if you have a $1,000 deductible you must pay for the first $1,000 worth of care before the insurance pays for anything. Also you get to individual plans where people have catastrophic insurance, meaning they have huge deductibles they know they won't meet and it just covers them for really expensive things (like a $10,000 deductible because that is the only way they can afford insurance). Service limitations occur with Chiropractic, PT, OT, and other therapies where multiple visits are required: ie you get 10 or so visits a year and the insurance doesn't cover any more visits. Then you have maximum amounts, ie insurance covers $500 worth of care and you are responsible for everything after that.

No it isn't and now you see why.

Because the cost of care is rising due to inflation AND we have an aging population. Lets not forget that Medicare started out in the hole, the first people to get it when it started didn't pay into it.

Trust me people DO care about the cost. They need help but if they can't afford it then it doesn't matter who they go to. Remember I deal with this every day I am on the battle lines so to speak.

I already covered this.
And many employers are doing this and patient seem to like it.

Just because you only have $15 copay doesn't mean that is average. Average for my office is $25 copay with some as high as $45 per visit! personal experience of 1 individual dealing with 1 plan is not a reflection of national trends.

[quote]Just moving the whole system to government pays vs. private insurance pays solves NOTHING if the two above problems are not fixed. And they can be fixed w/o making it a big new govt program.

 

I appreciate the lecture

Perhaps my overly simplistic example was meant to make the complex understandable.

ATTN everyone, simplistic analogies are no longer going to be allowed. To understand something complex like insurance you'll just have to suck it up and spend years studying the entire industry.

If you think the ONLY reasons insurance costs are skyrocketing are aging population and inflation then you are either ignorant or naive. Healthcare cost have been outstripping inflation by orders of magnitude for years, and that is obvious to even casual observers, or at least I thought so.

Any analysis that refuses to look at the lack of market incentives and med mal premiums is incomplete, and therefore totally worthless.

My point about copays is not that all copays in the universe are set at $15. $15 was an EXAMPLE. Whether your copay is $15 or $50, the issues is that's all you pay, and the insurance pays the rest. The consumer doesn't care and rarely knows the total cost of a visit/procedure.

 

And how much is malpractice insurance MR. Professor? I know my employer's cost and I know that compared to others it isn't bad AT ALL! But he is a chiropractor and they have some of the lowest rates in the industry. I know that it costs a lot but hey what are you going to do practice without it. It is a part of the game and people have to have it. Deal with it. If someone is paying as much in Malpractice as they pay themselves then there are some serious reasons why!

Ok so now you don't think that simplification is OK. Also I didn't mention it because you aready did. Do you want me to restate every part of your argument even those that I agree with?

Bull$hit. People do care. Just because you don't doesn't mean JACK! I have had people complain because our rates went up $10 dollars. And that was the charged amount not the allowable!

BTW if your copay is $50 and the allowable is less than that then you pay for all of the procedure and the insurance company pays NOTHING. Not only that but your provider should refund back or show as a balance what was not allowed for that procedure.

Once again you are talking about stuff you don't have a complete understanding of. Perhaps you should state your point and move on. I simply correct your 'oversimplification' of a complex topic to make sure others who don't deal with it for years and don't deal with it every day can understand it for what it truely is, a clusterf*ck but not a simple one.

As I said in my first post something does need to be done, I don't know what that is but something DOES need to be done.

 

A chiropractor probably isn't going to kill anyone

Insurance is not there to make sure providers get paid. They exist to make money for shareholders.

Physicians and hospitals do not even set the amount of money that is paid for procedures (except for the rare instance of self pay). The government sets what they think should be paid for expenses covered by Medicare/caid. That is how much they will pay. Insurance companies negotiate a multiple of that price with the healthcare providers when they allow them to see patients that have their policies. In effect, it is the government and insurance companies that dictate how much healthcare costs in this country unless you do not have insurance AND pay your own bill. Granted, what Congress allows is usually rooted in reality.

However, if you have the notion that a bunch of rich old doctors are sitting around smoking cigars and decide they are going to conspire to rip people off, that isn't quite right.

 

What is really frightening about threads like this are the number of people who truly believe that the answer to a problem is government involvement. Government is already far too involved in health care in this country

If you are comfortable with some 20 year old wet-behind-the-ears kid in a cubicle 500 miles away telling you what medicine or procedures you need than so be it. As for me, I don't want any bureaucrat (government or private industry) telling me what procedure I need to have or what I can afford nor do I believe I'm entitled to every procedure under the sun simply because I haven't assumed room temperature yet.

If we had to be responsible for our own health care costs and if “the world owes me something” types didn’t sue every time some procedure didn’t give them the result they want (regardless of whether the provided actually did anything wrong or not) we wouldn’t be seeing double-digit increases in costs year after year.

The less the government is involved in our lives and in our businesses the better no matter who is sitting in the White House.

 

Actually many companies plans already work like that...well similiar. The amount of medical costs used by the companys employees within a year, determine future years prices. Lets say if your company of 100 employees has a set amount of total costs for the year from the insurance company to determine premiums. If they go over the set amount, the costs the company has to pay will increase based upon the previous year. In turn the company will delegate some of the added costs to the employee. So if employees for whatever reasons do not get as sick, or need treatment as much, their insurance costs will not go up as much due to not going over the amounts the insurance company set when determining coverage prices..

OK I think I confused myself with that answer

 

BTW the PHARM companies lobbiests are the 2nd most influential in the country. Do not expect prices to be fixed or allowed to use foreign perscriptions any time soon. Sucks that it has gotten so corrupt.

 

Wow, there is soo much disinformation being thrown around here, it's hard to get a foothold back on reality:

According to the the Congressional Budget Office, medical malpractice tort costs account for less than two percent of healthcare spending. It's also interesting to note that the number of federal tort trials fell by 80% from '85-'03. ( proof: http://www.ojp.usdoj.gov/bjs/pub/press/fttv03pr.htm ).

Funny, huh? Why all the garbage about tort reform? Well, first off, it cuts into a businsses profits, and last time I looked, our politicians were bought and sold by businesses fairly regularly (see current Jack Abramhoff scandal for details). Secondly, trial lawyers seem to vote Democratic more-often-and-not. Crippling damage awards and would also neuter trial lawyers ability to support their favorite political interests. That would mean politicans would be putting political gain ahead of the best interests of the country. None of this should surprise you. How about this? If you looked at the stock market each and every year since the great depresion, one sector has outperformed every other: pharmeceuticals. The big pharmeceuticals spend more money on advertising than they do in research. Not quite the picture some would have you believe, huh?

The single biggest factor in healthcare expense is the performance of the stock market. Healthcare insurers are money-holding institutions. They take the monthly premiums & invest them. They pay out what they need to when they need to. Like any other publicly held company, it's board and executors are held accountable for the companies performance. When the stock market is down and the return on that invested money is down, what options are available to pickup income? Healthcare providers negotiate long-term healthcare contracts, stipulating what they will be paid for each and every service provided (hence the term "in-plan" or "network" healthcare provider). Your doctor's office will gladly tell you which insurance companies they accept. So, costs are basically fixed. So, what is left when you need to bump income? The insurance premium price -- which are often short 3 mo, 6 mo, or 12 mo contracts. Again, your doctor's office will tell you when they renegotiate their contracts. If they don't accept your current insurance company, you can often call them during that month. If they get enough requests, they'll seek negotiating a contract with that insurer. That exact thing happened at the pharmacy 4 blocks away from me. 2 years ago they didn't accept my insurance company -- today they do.

Healthcare is crippling this country in ways that you and I can only start to imagine. Picture this scenario: a mother is on welfare -- the dad's a bum & he's skipped town. State's offer a very basic level of healthcare to children whose parent is on welfare. If this mother picks up an entry level job, it's not going to offer healthcare for her child. So, even if this mother wants to work, she likely wont because it's going to require sacrificing her child's healthcare.

The key to reducing healthcare is fairly simple: increase competition. Profit margins are over-the-top at insurance companies and at pharmeceutical companies. If it were a true open-market, then somebody would've stepped in to undercut the others and swipe their business away. Same thing can be said for the oil companies: Exxon made $36b last year in profit.. about $1b every 10 days. Who the hell couldn't undercut that profit margin? Geez, bankroll me starting up an oil-importing-and-refining company & I'd "settle" for a measly $1m/day! I'd give an additional $10m/day to whoever helped bankroll me. We'd undercut Exxon by roughly $32b by the end of the year.

The bigger picture here is that special interests have taken hold of our government and our laws. In their never-ending-pursuit of larger and larger profits, they are choking the consumer-class in this nation.

 

I am one of the unfortunate SCREWED in the Health Insurance industy. The 'small' company I work for only pays 50% of the Employee and 0% of the Dependants. (We are in talkes to get 50% Dependants becasue the costs are driving people away). But in a nutshell, it is almost too expensive for our small company to take on such costs. Anyhow here's how it breaks down.

I'm 25, have a 23yr wife, 2yr daughter, and 8mo son. (Family of 4). We have Anthem insurance 250/500 (80/20) Plan.

Monthly Costs (mypart): $800.00 Yearly Costs: $9,600.00

Now before you all go tell me my job sucks and I should just find another job there are two reasons why I don't.
1) I make good money. If I factor in a Salary I would make as an Engineer for GM w/ good benefits, I would still make more even after subtracting the $9,600. So it doesn't bother me.
2) Small companies and even large companies are starting to do this. It's hard to find a job with excellent health care coverage because it's so bad anymore.

I don't know much about the Tort reform. But I am in stong support of Health Savings Accounts and allowing the Individual to attain these Tax Free. We will be switching to these someday in the next year or two when they become more prevelant and there is more competition.

Why? I can use the Chiropractor someone mentioned above as a great example. The Chiropractor I go to has had just as much (if not more) medical training then my Family Doctor.

Chiropractor Cost: $35.00 (Adjustment/Visit)

I go to my Family Doctor who doesn't even do an adjustment, she just listens to my Sinuses and tells me I have a Sinus infection and writes me a prescription.

Family Doctor Visit: $100.00 (Although I only pay a $15.00 Copay)


So why is there such a difference in price? The reason is party like Chris was saying in that most insurance companies offer Co-Pays for their visits and that is what they are used too. They don't know and don't even care the cost is $100.00.

Chiropractors can't afford the luxury as MOST INSURANCE COMPANIES DONOT COVER CHIROPRACTOR Treatments. Why does this matter. It matters because if Chiropractor X down the street charges $35.00, and Chiropractor Y down the street charges $100.00 then let me see a show of hands that would go to Chiropractor Y??? Ahhhh, Nobody. Now if Chiropractor Y is a 10x better Chiropractor then yes he is going to get some business, if not NO.

But the Chiropractor profession due to the fact Health Insurance is not typically involved has something that the Medical proffesion doesn't have. COMPETITION.

My solution, eliminate anything but Catostrophic Insurance ALTOGETHER. Then you will start seeing something that the Medical Proffession needs terribly, = Competition.

 

Huh?

 

You must have a full 4 year degree to enter Chiropractic school. Then 3.5 years in Chiropractic college with the entire first trimester being gross anatomy in addition to other classes. The second trimester is neural anatomy and other classes. The average class load in chiropractic college is 32 hours per trimester! Top load, without special permission from the school dean, in the undergrad program at my college was 17 hours. After graduating all chiropractors must pass the state boards which typically consist of, typically 4, a series of practical and academic tests. All chiropractors are liscenesed and approved only after passing their state boards, just like MDs and other healthcare professionals.

The only difference in schooling between chiropractic and MD school is residency because Chiro doesn't require it. I frankly am happy about not having to stay up for 2 days at a time and worry about killing someone by telling a nurse the wrong thing or something in the wrong order because I didn't get enough sleep.