This guy, president of the Charleston School of Law, suggests a fix I had not read about before. Maybe it has been out there, but I hadn't seen or heard it.
http://www.charlotteobserver.com/opinion/op-ed/article170495982.html
The basics (from the op/ed piece):
Instead of continuing to argue, let's work together to fix the system by shifting the most expensive illnesses to Medicare. That will lower the risks to health insurers who then can cut premiums by as much as 40 percent.
This idea can be the ultimate fix that makes health care affordable for most Americans.
Almost half of health care premiums are for catastrophic illnesses – the most expensive illnesses people experience. Two systems have developed to deal with these illnesses – the Medicare system for people 65 and older, and the system for everybody else.
People under 65 often are charged more than actual health costs because medical providers often take advantage of enhanced billing to recoup some of the costs they incur for treating people without insurance. These "cost-shifts" are variable costs that are hard to control, which leads insurers to charge a lot for premiums of people under 65.
But if you are covered by Medicare, the program pays actual costs to a medical provider. Because Medicare only pays actual costs, the overall cost of treatment for the Medicare patient is much less than for the patient under 65.
The difference in costs is amazing, according to research by the Charleston School of Law. Consider a patient under 65 who has an average catastrophic medical bill of $1.6 million. The cost for a Medicare patient with the same illness: about $320,000, or 80 percent less. That's a savings of more than $1 million.
Imagine if we could get those savings hundreds of thousands of times. This proposal would remove the costs associated with catastrophic illnesses out of the cost for insurance premiums of Americans under 65. In turn, all of the costs for catastrophic illnesses would be protected under Medicare.
It's an interesting thesis. As you read the whole thing, he doesn't go into any possible negatives but there must be some.
Would this drive up the price of Medicare, necessitating higher payroll taxes? Would it be a non-starter because the insurance lobby is too powerful?
Maybe I'm missing something else, but this sure sounds like something at least worth considering.
Scoopers, this does not have to be a political discussion.
For my part, I will not make it political; I won't even respond to those who do.
Intriguing option. For healthcare providers, there's a definite drawback that Medicare doesn't pay as well (as the article indicates) so this would likely hurt profit margins. I do also think it could raise Medicare premiums and tax requirements.
Still, an interesting proposal. I would argue a lack of universal healthcare in this country shows that we're closer to the third world than the first in terms of healthcare, and the longer we avoid single payer the worse off we are as a nation. But this might be worth a shot.
My biggest worry is that this won't fix the "ER as primary care" problem that is rampant in our society. Especially as people that currently rely on Medicare for their primary insurance may lose that option and not go to the private companies. This may help the markets, but hurt the hospitals.
Quote from: MU82 on September 01, 2017, 01:41:19 PM
This guy, president of the Charleston School of Law, suggests a fix I had not read about before. Maybe it has been out there, but I hadn't seen or heard it.
http://www.charlotteobserver.com/opinion/op-ed/article170495982.html
The basics (from the op/ed piece):
Instead of continuing to argue, let's work together to fix the system by shifting the most expensive illnesses to Medicare. That will lower the risks to health insurers who then can cut premiums by as much as 40 percent.
This idea can be the ultimate fix that makes health care affordable for most Americans.
Almost half of health care premiums are for catastrophic illnesses – the most expensive illnesses people experience. Two systems have developed to deal with these illnesses – the Medicare system for people 65 and older, and the system for everybody else.
People under 65 often are charged more than actual health costs because medical providers often take advantage of enhanced billing to recoup some of the costs they incur for treating people without insurance. These "cost-shifts" are variable costs that are hard to control, which leads insurers to charge a lot for premiums of people under 65.
But if you are covered by Medicare, the program pays actual costs to a medical provider. Because Medicare only pays actual costs, the overall cost of treatment for the Medicare patient is much less than for the patient under 65.
The difference in costs is amazing, according to research by the Charleston School of Law. Consider a patient under 65 who has an average catastrophic medical bill of $1.6 million. The cost for a Medicare patient with the same illness: about $320,000, or 80 percent less. That's a savings of more than $1 million.
Imagine if we could get those savings hundreds of thousands of times. This proposal would remove the costs associated with catastrophic illnesses out of the cost for insurance premiums of Americans under 65. In turn, all of the costs for catastrophic illnesses would be protected under Medicare.
It's an interesting thesis. As you read the whole thing, he doesn't go into any possible negatives but there must be some.
Would this drive up the price of Medicare, necessitating higher payroll taxes? Would it be a non-starter because the insurance lobby is too powerful?
Maybe I'm missing something else, but this sure sounds like something at least worth considering.
Scoopers, this does not have to be a political discussion.
For my part, I will not make it political; I won't even respond to those who do.
It's not feasible because the premise that Medicare covers only cost is wrong. In some instances Medicare pays less then cost of treatments, the providers then pass that cost on to private insurance. So you are taking all the areas of experimental experimental treatments and high cost and putting it in one non-profitable place.
As I've been a healthcare provider for almost 2 years now, I've done a lot of reading on the topic. I've come to agree with a few things.
1. I don't believe it's the costs of healthcare that are a problem. It's the charges.
2. Health insurance is the biggest barrier to good healthcare in this country. After that is costs from pharma, medical devices
De-couple health insurance from employment. Make people/families buy individually from companies (similar to auto insurance). Tell health insurance companies they can compete freely across state lines. Make the free market work for the consumer and watch finances (eventually) be much more reasonable.
Government assistance (at the state and federal level) will still be needed.
Quote from: jesmu84 on September 01, 2017, 04:41:34 PM
As I've been a healthcare provider for almost 2 years now, I've done a lot of reading on the topic. I've come to agree with a few things.
1. I don't believe it's the costs of healthcare that are a problem. It's the charges.
2. Health insurance is the biggest barrier to good healthcare in this country. After that is costs from pharma, medical devices
De-couple health insurance from employment. Make people/families buy individually from companies (similar to auto insurance). Tell health insurance companies they can compete freely across state lines. Make the free market work for the consumer and watch finances (eventually) be much more reasonable.
Government assistance (at the state and federal level) will still be needed.
Interesting. Certainly would be painful at first, but might work.n You're elected!
Some people fail to understand the system was broken way longer than 10 years ago. It has only gotten worse with the patchwork plan put in place this decade.
Quote from: jesmu84 on September 01, 2017, 04:41:34 PM
As I've been a healthcare provider for almost 2 years now, I've done a lot of reading on the topic. I've come to agree with a few things.
1. I don't believe it's the costs of healthcare that are a problem. It's the charges.
2. Health insurance is the biggest barrier to good healthcare in this country. After that is costs from pharma, medical devices
De-couple health insurance from employment. Make people/families buy individually from companies (similar to auto insurance). Tell health insurance companies they can compete freely across state lines. Make the free market work for the consumer and watch finances (eventually) be much more reasonable.
Government assistance (at the state and federal level) will still be needed.
I agree with this analysis.
Quote from: mu03eng on September 01, 2017, 02:02:49 PM
It's not feasible because the premise that Medicare covers only cost is wrong. In some instances Medicare pays less then cost of treatments, the providers then pass that cost on to private insurance. So you are taking all the areas of experimental experimental treatments and high cost and putting it in one non-profitable place.
Correct.
If people who need high-cost services were all shifted to Medicare, the cost-shift to private insurers would have to be even greater.
Quote from: jesmu84 on September 01, 2017, 04:41:34 PM
As I've been a healthcare provider for almost 2 years now, I've done a lot of reading on the topic. I've come to agree with a few things.
1. I don't believe it's the costs of healthcare that are a problem. It's the charges.
2. Health insurance is the biggest barrier to good healthcare in this country. After that is costs from pharma, medical devices
De-couple health insurance from employment. Make people/families buy individually from companies (similar to auto insurance). Tell health insurance companies they can compete freely across state lines. Make the free market work for the consumer and watch finances (eventually) be much more reasonable.
Government assistance (at the state and federal level) will still be needed.
This is 100% correct
Quote from: jesmu84 on September 01, 2017, 04:41:34 PM
2. Health insurance is the biggest barrier to good healthcare in this country. After that is costs from pharma, medical devices
Actually, it's the reverse.
And if you make it a free market where people just buy what they want and can afford, we'll go back to the pre-Medicare days. Wealthy people will get great care; poor people will get none.
Quote from: GooooMarquette on September 01, 2017, 09:06:46 PM
Actually, it's the reverse.
And if you make it a free market where people just buy what they want and can afford, we'll go back to the pre-Medicare days. Wealthy people will get great care; poor people will get none.
you're kidding, right? "none"??
Quote from: rocket surgeon on September 01, 2017, 10:18:46 PM
you're kidding, right? "none"??
History is your friend. Before Medicare and Medicaid (when it was a free market), many poor people simply could not afford care.
So yeah - none.
Quote from: jesmu84 on September 01, 2017, 04:41:34 PM
As I've been a healthcare provider for almost 2 years now, I've done a lot of reading on the topic. I've come to agree with a few things.
1. I don't believe it's the costs of healthcare that are a problem. It's the charges.
2. Health insurance is the biggest barrier to good healthcare in this country. After that is costs from pharma, medical devices
De-couple health insurance from employment. Make people/families buy individually from companies (similar to auto insurance). Tell health insurance companies they can compete freely across state lines. Make the free market work for the consumer and watch finances (eventually) be much more reasonable.
Government assistance (at the state and federal level) will still be needed.
Sound thinking. However, public opinion is moving toward a single payer system. How do we reconcile the impending momentum toward a system borne out of government with a halcyon viewpoint that the free market can work well for the consumer?
Quote from: GooooMarquette on September 01, 2017, 09:06:46 PM
Actually, it's the reverse.
And if you make it a free market where people just buy what they want and can afford, we'll go back to the pre-Medicare days. Wealthy people will get great care; poor people will get none.
Note that I said government assistance will still be needed. How to reconcile.that is difficult, admittedly
Quote from: Golden Avalanche on September 01, 2017, 10:50:15 PM
Sound thinking. However, public opinion is moving toward a single payer system. How do we reconcile the impending momentum toward a system borne out of government with a halcyon viewpoint that the free market can work well for the consumer?
Good question. I don't know how you do that. I don't have all the answers. Getting rid of insurance companies would be the most ideal. Beyond that, you've gotta diminish their power considerably to decrease costs and increase access.
Quote from: jesmu84 on September 01, 2017, 04:41:34 PM
As I've been a healthcare provider for almost 2 years now, I've done a lot of reading on the topic. I've come to agree with a few things.
1. I don't believe it's the costs of healthcare that are a problem. It's the charges.
2. Health insurance is the biggest barrier to good healthcare in this country. After that is costs from pharma, medical devices
De-couple health insurance from employment. Make people/families buy individually from companies (similar to auto insurance). Tell health insurance companies they can compete freely across state lines. Make the free market work for the consumer and watch finances (eventually) be much more reasonable.
Government assistance (at the state and federal level) will still be needed.
Good analysis except maybe the selling across state lines. While it sounds like a great concept, it would only work in isolated cases, because hospitals, for the most part, aren't franchised. My wife's insurance covers the Racine hospitals and Froedert. That would be worthless to anyone not living in SE Wisconsin other than the few who live right across the border. It wouldn't do any good for her to buy insurance that was 50% cheaper if it was based somewhere in Ohio.
So, while it could help in a few areas, for the most part it wouldn't be relevant.
Quote from: jesmu84 on September 01, 2017, 04:41:34 PM
As I've been a healthcare provider for almost 2 years now, I've done a lot of reading on the topic. I've come to agree with a few things.
1. I don't believe it's the costs of healthcare that are a problem. It's the charges.
2. Health insurance is the biggest barrier to good healthcare in this country. After that is costs from pharma, medical devices
De-couple health insurance from employment. Make people/families buy individually from companies (similar to auto insurance). Tell health insurance companies they can compete freely across state lines. Make the free market work for the consumer and watch finances (eventually) be much more reasonable.
Government assistance (at the state and federal level) will still be needed.
I'm not an expert in this field at all, but what evidence do you have that the free market would make health care more affordable to the average american?
Health-care is a need. There is limited access, high demand and one cannot simply go without. Those scenarios do not bode well for the consumer.
Quote from: GooooMarquette on September 01, 2017, 10:25:40 PM
History is your friend. Before Medicare and Medicaid (when it was a free market), many poor people simply could not afford care.
So yeah - none.
you are right-BEFORE m-care/m-caid, poor people could not afford health care. medicare goes back to the early 1900's and medicare to 1965. health insurance companies started out as more of an accident coverage against steamboat and railway incidents and evolved from there around 1890's or so. but you've got to keep this in perspective as our healthcare system wasn't near what it is today-research, diagnostics, facilities, pharmaceuticals, lawyers, etc. history has shown that people have RARELY been denied healthcare as needed
our gubmint will NEVER, EVER allow those 2 single payer plans to go away. they are more than the 3rd rail of politics. if you ever want to really see pitch forks and torches descend upon capital hill...
interesting you mention history and i don't mean putting words in your mouth, but your alluding to it repeating itself. hmmmmm-wishing others would apply this same line of thinking to everything else swirling like a turd ferguson down the proverbial drain as opposed to going all "al queda" on it
Quote from: forgetful on September 02, 2017, 01:09:03 AM
I'm not an expert in this field at all, but what evidence do you have that the free market would make health care more affordable to the average american?
Health-care is a need. There is limited access, high demand and one cannot simply go without. Those scenarios do not bode well for the consumer.
never saw the day i'd be defending jesmu, but he was right on
"De-couple health insurance from employment. Make people/families buy individually from companies (similar to auto insurance). Tell health insurance companies they can compete freely across state lines. Make the free market work for the consumer and watch finances (eventually) be much more reasonable. "
in order for the free market to have a chance, the government must get out of the way; not completely as we still should require licensure requirements of it's docs and insurance oversight. add tort reform to the mix-especially the class actions-have you ever suffered from fill-in-the-blank side effect from fill-in-the-blank medication blah blah blah. they(attorneys) win, you get a coupon
Quote from: jesmu84 on September 01, 2017, 11:25:48 PM
Note that I said government assistance will still be needed. How to reconcile.that is difficult, admittedly
So Obamacare, with the tweak that insurers can sell across state lines.
Quote from: rocket surgeon on September 02, 2017, 05:11:32 AM
interesting you mention history and i don't mean putting words in your mouth, but your alluding to it repeating itself. hmmmmm-wishing others would apply this same line of thinking to everything else swirling like a turd ferguson down the proverbial drain as opposed to going all "al queda" on it
I wasn't alluding to it repeating itself. I was saying it won't...
Quote from: rocket surgeon on September 02, 2017, 05:30:41 AM
never saw the day i'd be defending jesmu, but he was right on
"De-couple health insurance from employment. Make people/families buy individually from companies (similar to auto insurance). Tell health insurance companies they can compete freely across state lines. Make the free market work for the consumer and watch finances (eventually) be much more reasonable. "
in order for the free market to have a chance, the government must get out of the way; not completely as we still should require licensure requirements of it's docs and insurance oversight. add tort reform to the mix-especially the class actions-have you ever suffered from fill-in-the-blank side effect from fill-in-the-blank medication blah blah blah. they(attorneys) win, you get a coupon
You do highlight some of the problems though. It will never be a free market because of license requirements etc., so supply will always be fixed. Tort reform has been shown to have nearly zero effect on costs as it is a drop in the bucket compared to the overall cost of medicine.
I just don't see how changing how competition works on the insurance side, will affect costs for actual medical care. That is like saying if we allowed the sale of car insurance across state lines we'd decrease the cost of car repairs. It may be incorrect, but I certainly don't get it.
Someone give me an example of free market healthcare system in the history of planet Earth that has these amazing benefits everyone keeps cheering.
"I just don't see how changing how competition works on the insurance side, will affect costs for actual medical care. That is like saying if we allowed the sale of car insurance across state lines we'd decrease the cost of car repairs. It may be incorrect, but I certainly don't get it. "
i look at it this way-like a cat chasing it's tail-insurance companies raising rates to keep up with increasing medical costs and medical (and dental for that matter) continue to raise costs because insurance companies continue to take MORE than their fair share, in our humble opinions
i am better off charging my patients 20-30%(sometimes 40%) less and eliminating the insurance companies altogether. no paper work, no write-offs or write-downs, less work for front office. the patient saves on the premiums, the waiting time for pre-authorizations, and have the freedom to pay for what they want, when they want, including no yearly maximum allowable benefit$$
eliminating the yearly max can save money as the patient can attend to the issues sooner before they become bigger, more costly issues. most patients, when they hit their yearly max, regardless if all of there diagnosed treatment is completed-stop. more offices are creating their own "in-house" options for the un-insured and under-insured as well as those who just do not like their existing plans. they cannot double dip however-we cannot offer our plans either before or after they have their own insurance coverage applied
I am on medicare. I go every other month for a vitamin B12 shot because I am B12 deficient. At that 15 minute office visit I have all my vitals checked in addition to the shot. My doctor charges medicare 15 dollars for the visit., which I believe is reasonable. When I get these this is not a bill statements from CMS I see medicare allows only a 45 cents payment to the physician which they pay only 36 cents while my co-insurer pay the other 9 cents. How are doctors suppose manage a practice with those reimbursements? If he pays the nurse 20 buck an hour that visit already costs him 5 bucks. Single payer or medicare for all may sound like a great idea, but we won't have any doctors who will accept it at those rates.
Quote from: muwarrior69 on September 02, 2017, 03:30:29 PM
I am on medicare. I go every other month for a vitamin B12 shot because I am B12 deficient. At that 15 minute office visit I have all my vitals checked in addition to the shot. My doctor charges medicare 15 dollars for the visit., which I believe is reasonable. When I get these this is not a bill statements from CMS I see medicare allows only a 45 cents payment to the physician which they pay only 36 cents while my co-insurer pay the other 9 cents. How are doctors suppose manage a practice with those reimbursements? If he pays the nurse 20 buck an hour that visit already costs him 5 bucks. Single payer or medicare for all may sound like a great idea, but we won't have any doctors who will accept it at those rates.
Medicare and especially Medicaid come nowhere close to covering the actual cost of treatment. That's why private insurance subsidizes the difference. The only way a single payer system could work would be if they established rates somewhere between the rates paid by Medicare/Medicaid and private insurers.
Another piece of the puzzle (unfortunately a long ways down the road) is to replace fee-for-service payments with value-based payments. The current system incentivizes providers to provide more service, but not necessarily better outcomes. Some providers have long been advocating for this new methodology, but the devil is in the detail so it will still be quite a while before that becomes the predominant payment methodology.
Quote from: muwarrior69 on September 02, 2017, 03:30:29 PM
I am on medicare. I go every other month for a vitamin B12 shot because I am B12 deficient. At that 15 minute office visit I have all my vitals checked in addition to the shot. My doctor charges medicare 15 dollars for the visit., which I believe is reasonable. When I get these this is not a bill statements from CMS I see medicare allows only a 45 cents payment to the physician which they pay only 36 cents while my co-insurer pay the other 9 cents. How are doctors suppose manage a practice with those reimbursements? If he pays the nurse 20 buck an hour that visit already costs him 5 bucks. Single payer or medicare for all may sound like a great idea, but we won't have any doctors who will accept it at those rates.
Bingo. My internist loses money every time she sees me.
Quote from: muwarrior69 on September 02, 2017, 03:30:29 PM
I am on medicare. I go every other month for a vitamin B12 shot because I am B12 deficient. At that 15 minute office visit I have all my vitals checked in addition to the shot. My doctor charges medicare 15 dollars for the visit., which I believe is reasonable. When I get these this is not a bill statements from CMS I see medicare allows only a 45 cents payment to the physician which they pay only 36 cents while my co-insurer pay the other 9 cents. How are doctors suppose manage a practice with those reimbursements? If he pays the nurse 20 buck an hour that visit already costs him 5 bucks. Single payer or medicare for all may sound like a great idea, but we won't have any doctors who will accept it at those rates.
One thing to remember is that Medicare/Medicaid also has to deal with avoiding unnecessary treatments. Vitamin B12 shots are often not needed, but doctors give them because it guarantees monthly visits. Most can supplement B12 orally if they are deficient. There are cases where it cannot, because of issues with absorption (which is often a sign of H. pylori infection, which should be treated).
There is a medicare approved condition to assure B12 payment, which is then often miscoded to get paid for something that is not medically necessary.
I do wonder how your doctor is coding this, because the actual reimbursement rate for B12 injections is higher than you are reporting.
I repeat, please point to free market example in health care that has worked. Americans are becoming more unhealthy, fatter, more heart disease, higher cholesterol, coupled with a society that generally wants people to live as long as possible. Not trying to be crass or mean, but I don't see how the free market can correct our health care system with more and more unhealthy people, with doctors who need lots of training (and are in the decline?), plus people who want to love as long as possible with exorbitant costs.
Don't know the answers, but not convinced it's as easy as making it open market and allowing folks to buy insurance across state lines.
Quote from: reinko on September 02, 2017, 06:55:48 PM
I repeat, please point to free market example in health care that has worked. Americans are becoming more unhealthy, fatter, more heart disease, higher cholesterol
If Americans are, as you say, becoming more unhealthy as the government and the PI attorneys get more and more involved I think you just answered your own question.
Quote from: muwarrior69 on September 02, 2017, 03:30:29 PM
I am on medicare. I go every other month for a vitamin B12 shot because I am B12 deficient. At that 15 minute office visit I have all my vitals checked in addition to the shot. My doctor charges medicare 15 dollars for the visit., which I believe is reasonable. When I get these this is not a bill statements from CMS I see medicare allows only a 45 cents payment to the physician which they pay only 36 cents while my co-insurer pay the other 9 cents. How are doctors suppose manage a practice with those reimbursements? If he pays the nurse 20 buck an hour that visit already costs him 5 bucks. Single payer or medicare for all may sound like a great idea, but we won't have any doctors who will accept it at those rates.
Single payer is the way to go but we need a complete overhaul. Big pharma needs to be strangled for how they treat patients. Price gouging for routine procedures needs to be amended. Unnecessary charges need to be done away with.
If you take a ride with a certain private ambulance company in Milwaukee, you'll notice the crew change their gloves at least once. That's so they can double bill for gloves at a rate that is insanely inflated. Crap like that is common practice for most healthcare providers.
The rest of the world is providing healthcare cheaper, and anyone thinking we have some magically better access or technology is nuts. The system is broken. It needs to be rebuilt, and not just on the insurance end. Saving lives should not be a for profit business.
We don't need single payer... we need no-payer. As in stop paying for unnecessary treatments. Prohibit transplants for anyone over 55. Ban drugs that don't materially postpone death or improve quality of life. Legalize euthanasia and marijuana. Put Dr. Oz in jail. Etc.
In my humble opinion the biggest problem is people don't see the cost of things... they just 'claim it to insurance'. This is the first thing that needs to be fixed... how to fix it?
a) put the power in the hands of the consumers - eliminate corporate insurance and make it mandatory (like Switzerland or Netherlands) for people to buy their own insurance
b) make consumers understand the cost of the treatment they desire. Even in countries with mandatory insurance, the consumer can choose their medical provider based on what they can afford and what their insurance will pay.
c) Put better regulations about medical malpractice in place. Eliminate frivolous claims that drive up insurance rates for providers which drives up costs.
d) Eliminate all forms of government sponsored health care. No government is capable of managing something this big. I've lived in England and the reason BUPA exists is because the NHS is a clusterf*&K. Government can subsidize insurance rates for the poor, but should have no hand in care decisions, reimbursement amounts, or even the quality of care provided.
I've lived in lots of countries and seen lots of medical and insurance systems. After all that experience, "cash and carry" is still my favorite, but the above works in a large society and takes care of the poor as well.
Benny and Warrior Fan get my vote for HHS co-czars.
Brew, not so much.
Quote from: Pakuni on September 03, 2017, 11:11:29 AM
Why 55?
yeah-that's only 5 years in to the champions tour
in what other business, other than attorneys, can you walk out of the place, getting some sort of service or tangible good(s) and not knowing what it cost until you open the bill a few days later? like a box of chocolates, enn'a so? i've heard where 2 people, on the same day, having the same issue attended to and getting 2 completely different bills...by a lot!
Quote from: Benny B on September 02, 2017, 11:42:34 PM
We don't need single payer... we need no-payer. As in stop paying for unnecessary treatments. Prohibit transplants for anyone over 55. Ban drugs that don't materially postpone death or improve quality of life. Legalize euthanasia and marijuana. Put Dr. Oz in jail. Etc.
I agree with this...except for maybe the choice of age 55. How about 65.
A significant issue is that we are a country that values long life. With long life, comes high high costs, but as a society we have generally accepted the fact that we want to live as long as possible. A three month stint in intensive care for a 95 year old person costs more than cancer treatment for a toddler.
Before you call me granny killer, I support families to make the best decisions for themselves, but all the econ wizards on this board who think we can solve this problem by selling insurance across state lines or using "free market" principles are kidding themselves.
Quote from: reinko on September 03, 2017, 02:13:34 PM
A significant issue is that we are a country that values long life. With long life, comes high high costs, but as a society we have generally accepted the fact that we want to live as long as possible. A three month stint in intensive care for a 95 year old person costs more than cancer treatment for a toddler.
Before you call me granny killer, I support families to make the best decisions for themselves, but all the econ wizards on this board who think we can solve this problem by selling insurance across state lines or using "free market" principles are kidding themselves.
i get your point, BUT the 95 year old would be covered by medicare-yes i know that's you and i. the toddler would be covered by hopefully private insurance/mom and dad's. that is the risk insurance companies must take and is spread around within the pools they create.
selling insurance across state lines is like geico vs progressive, etc etc should have good actuaries to create the competitive pools which should be competitively priced for all involved;both the company and the enrolled.
one more thing as i alluded to previously-the medical field needs to be compelled to transparency of fees like most other businesses. in the dental world, we can't have multiple fee schedules. get rid of the ala carte crap. i.e. charge per glove, piece of gauze, box of kleenex(nasal discharge apparatus)
Quote from: rocket surgeon on September 03, 2017, 04:22:11 PM
i get your point, BUT the 95 year old would be covered by medicare-yes i know that's you and i. the toddler would be covered by hopefully private insurance/mom and dad's. that is the risk insurance companies must take and is spread around within the pools they create.
selling insurance across state lines is like geico vs progressive, etc etc should have good actuaries to create the competitive pools which should be competitively priced for all involved;both the company and the enrolled.
one more thing as i alluded to previously-the medical field needs to be compelled to transparency of fees like most other businesses. in the dental world, we can't have multiple fee schedules. get rid of the ala carte crap. i.e. charge per glove, piece of gauze, box of kleenex(nasal discharge apparatus)
No doubt RS, but their are really old and really sick people in every state across the country. Not too mention I live in a statically "healthy" state (Massachusetts, I know surprise surprise), you think my state wants anything to do with "unhealthy" states like West Virginia, Alabama, Mississippi...) when it comes to helping to bring down costs?
I get it, it's super complicated, and not too mention emotional when it comes to care, but I have yet to see a realistic free market solution to health care.
solid article right here (from earlier today)
https://finance.yahoo.com/news/frustration-mounts-over-premiums-individual-120517040.html
most relevant part, IMO:
A suggestion that she could qualify for financial assistance by earning less only irritates her more. "My whole beef is that the government is telling me: 'If you work less, we'll give you more,'" said Thornton, who's in her 50s.
If people such as Thornton drop out, they not only gamble with their own health. Their departure also means the group left behind gets costlier to cover as healthier customers bail out. That's counter to the whole idea of insurance, which involves pooling risk.
Quote from: reinko on September 03, 2017, 04:55:28 PM
No doubt RS, but their are really old and really sick people in every state across the country. Not too mention I live in a statically "healthy" state (Massachusetts, I know surprise surprise), you think my state wants anything to do with "unhealthy" states like West Virginia, Alabama, Mississippi...) when it comes to helping to bring down costs?
I get it, it's super complicated, and not too mention emotional when it comes to care, but I have yet to see a realistic free market solution to health care.
"I live in a statically "healthy" state" don't ya hate having to keep up with the jones's too? ;)
i find it kinda weird that we have some of the "smartest" people in the world working on this for us too ::) funny thing what money does to muck things up for us.
Quote from: rocket surgeon on September 03, 2017, 06:53:41 PM
"I live in a statically "healthy" state" don't ya hate having to keep up with the jones's too? ;)
i find it kinda weird that we have some of the "smartest" people in the world working on this for us too ::) funny thing what money does to muck things up for us.
Yeah, I had a typo, but Massachusetts has one of the lowest uninsured rates, mandatory youth coverage, one of the lowest rates from obesity/heart disease, yadda yadda...why would MA (or really its insurers) or any other of the statistically healthy states open up its market to states that have more unhealthy people?
Quote from: reinko on September 03, 2017, 07:19:57 PM
Yeah, I had a typo, but Massachusetts has one of the lowest uninsured rates, mandatory youth coverage, one of the lowest rates from obesity/heart disease, yadda yadda...why would MA (or really its insurers) or any other of the statistically healthy states open up its market to states that have more unhealthy people?
not poking you about typo-knew what you meant. i was saying as you live in a healthy state puts more pressure on you to just say no to culvers, et.al. ;D i see what you mean though-only thing i can say is, sprinkle in a few unhealthy with more healthy and try to cover their arses. put some incentives in...?
Anyone believe physician compensation is messed up?
Also, healthcare employees are very high users of healthcare in general.
Quote from: real QG chili 83 on September 03, 2017, 08:38:04 PM
Also, healthcare employees are very high users of healthcare in general.
do you mean the pharmaceuticals part of healthcare?
Quote from: reinko on September 02, 2017, 06:55:48 PM
plus people who want to love as long as possible with exorbitant costs.
I want to love at least a half-hour, but I admit I rarely last that long.
As for the cost, you'll have to ask Mrs. 82!
Quote from: real QG chili 83 on September 03, 2017, 08:38:04 PM
Also, healthcare employees are very high users of healthcare in general.
Do you have any evidence to support this?
Quote from: real QG chili 83 on September 03, 2017, 08:36:36 PM
Anyone believe physician compensation is messed up?
Yes, hospitals predominately don't make money off of the procedures themselves, where they make the money is off the after care services where there are considerably lower labor costs.
Part of the compensation issue is certification/degree creep going on in the industry. A lot of would be doctors are choosing to go to PA school instead because it's only 6 years of school instead of at least 8 to be a full fledged doctor and in most cases the PA's are seeing the majority of the non-surgical patients.
As another example the APTA is currently advocating that all future PT degrees be doctorial degrees with at least a year of internship meaning physical therapists of the future would all have to go to school/intern for 7-8 years and incur lots of additional debt without any appreciable difference in capability.
Much like the tax system in this country, the medical system is outdated and in bad need of an overall and it's not just the insurance industry.
Quote from: mu03eng on September 05, 2017, 07:59:43 AM
A lot of would be doctors are choosing to go to PA school instead because it's only 6 years of school instead of at least 8 to be a full fledged doctor and in most cases the PA's are seeing the majority of the non-surgical patients.
This is very misleading. Although a lot of people are going the PA school route instead of medical school for the reasons you are saying, it has no impact on the number of doctors.
The number of seats in medical school and residency positions are fixed. There are around 500 students applying for each available seat in medical school.
Non-surgical doctors are often greatly overpaid, because they can easily be replaced by a nurse practitioner or PA, with actually better care.
NPs and PAs are also coming from individuals that never planned to go the doctor route. My wife looked into a PA program and she's a medical lab tech who never considered becoming a doctor. A friend at work recently got his NP license with his primary medical background being a paramedic. Another buddy at an old job had NP as his main goal from the start because he could practice sooner with a better bang for his buck in terms of salary to education ratio.
There may be more NPs and PAs now than there were, but many of them never considered going the MD route.