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The profit-obsessed monster destroying American emergency rooms

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Re: The profit-obsessed monster destroying American emergency rooms

#141

Post by vundercind »

JamesBarney wrote: post #138
Retric wrote: post #104

Earlier quoted context omitted.

Netherlands has a mostly public system with heavily subsidized mandatory non-profit insurance under government oversight: Health insurers receive compensation for high risk individuals from the government,[5] and government subsidies pay about 75% of insurance costs. https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands Israel also has a public healthcare system in practice. Mandatory participation in 1 of 4 no…

Yes health care is very different in every country in the world. There are a 1000 ways to do it well but the US is unique in having insane healthcare costs. Having non profit insurance companies isn't the difference, having mandatory health insurance isn't the difference. It's not that easy to fix.

The unifying factor of ~all other developed-world systems is price controls, de facto (e.g. government monopsony or [near-]monopoly) or de jure (outright pricing sheets)

Re: The profit-obsessed monster destroying American emergency rooms

#142

Post by therealdrag0 »

skybrian wrote: post #101
swatcoder wrote: post #86

Earlier quoted context omitted.

You're welcome to take it as foolish pre-modern ignorance if it strikes you that way, but actually yes: many people do not think to go to a doctor for minor bone injuries or vomiting, and many more than that wouldn't think to do so for more common everyday illnesses like a familiar sore throat, rash, nosebleed, fever, etc For some, this is rooted in a confidence in their own personal-community care, for others its an…

I haven’t heard of some of this and it raises a whole lot of questions. Can you tell us more? What is a “minor bone injury?” What sort of alternative healthcare do they use instead to treat it? Maybe give us an example of some people who do this?

I kicked a table and am 90% sure I broke my pinky toe which turned black and doubled in size. I didn’t go to doctor because I knew they wouldn’t do anything. A month later it’s back to normal.

A friend did the same but got a doctor scan; they confirmed it was broke but did nothing else.

Re: The profit-obsessed monster destroying American emergency rooms

#143

Post by therealdrag0 »

hintymad wrote: post #105

A key question is why the free market does not work in this case. Many business are "profit obsessed", yet it does not mean they won't provide quality products or services at increasingly lower prices. What's different in the health care?

It’s not a free market

Re: The profit-obsessed monster destroying American emergency rooms

#144

Post by vundercind »

eadmund wrote: post #103
philwelch wrote: post #57

Earlier quoted context omitted.

I’ve long been a proponent of high deductible plans. The part you’re missing is that you also get the opportunity to contribute pre-tax money to a Health Savings Account, which is money that you get to keep (and even invest) over the long term. You can spend that HSA money on medical expenses but if you save it, it turns into another tax-advantaged savings account like your IRA and 401(k).

HSAs can be wonderful, but you absolutely have to have a good one. Some of them still pay less than 1% interest and charge monthly fees. The ones which can be invested and have no fees are an amazing savings tool.

Indeed—the people who get by far the most benefit out of them are those who can afford to pay for everything without taking money out of the HSA, then claim those expenses much later in retirement (when you can also just start taking money out). To them, it’s another tax-advantaged retirement account, significantly raising their max annual contribution limits.

Re: The profit-obsessed monster destroying American emergency rooms

#145

Post by titanomachy »

phil21 wrote: post #85
titanomachy wrote: post #25

Earlier quoted context omitted.

$300 is your part of a regular doctor visit? Or the total bill? Do you have one of those high-deductible plans designed to discourage people from seeking any healthcare?

High deductible plans are great. They are designed to allow you to take pretax money out and use it to either invest like an IRA or spend it on healthcare. In other words they are actually insurance. Not a prepaid healthcare plan. No one should be using “insurance” to cover every day expected expenses like random doctor visits for the flu. They are a small fight against the massive principal agent problem which is th…

"No one should be using 'insurance' to cover every day expected expenses like random doctor visits for the flu."

If it was like $20, sure, but when a "routine doctor visit" costs $300 I'd rather use insurance than deal with the mental load of deciding if it's worth the money. I wonder how many people develop more serious conditions because their high deductible tips the calculus towards avoiding the doctor.

Re: The profit-obsessed monster destroying American emergency rooms

#146

Post by ywvcbk »

llamaimperative wrote: post #111
eadmund wrote: post #102

Earlier quoted context omitted.

Switzerland has a private insurance model IIRC. Israel and the Netherlands, too, according to Wikipedia.

Switzerland has individually mandated, state-approved, non-profit private insurance. Totally unlike the US's private insurance in every way that matters.

It’s kind of like Obamacare without a huge number of compromises

> non-profit private insurance

Only base/minimum coverage, the same companies still offer extended/supplemental plans with no such limitations.

Also is the for profit part really that important? Profit margins are capped and even if all insurance companies became non profit and costs went down went down by another 5-10% or so at most, would that fundamentally change anything? The extreme inefficiency seems like a mich bigger issue.

Re: The profit-obsessed monster destroying American emergency rooms

#147

Post by analog31 »

The ER is to some extent a fictitious entity. Politicians took to blaming the poor for abusing their access to ER's. But healthcare is anything if not statistical. They can figure out how many patients walk into an ER, who could be served in an urgent care setting, and provide those services on site. In fact, the ER closest to my house works in exactly this way.

Re: The profit-obsessed monster destroying American emergency rooms

#148

Post by philwelch »

PaulDavisThe1st wrote: post #135
philwelch wrote: post #57

Earlier quoted context omitted.

I’ve long been a proponent of high deductible plans. The part you’re missing is that you also get the opportunity to contribute pre-tax money to a Health Savings Account, which is money that you get to keep (and even invest) over the long term. You can spend that HSA money on medical expenses but if you save it, it turns into another tax-advantaged savings account like your IRA and 401(k).

> The part you’re missing is that you also get the opportunity to contribute pre-tax money to a Health Savings Account Post-ACA, high-deductible and HSA-compatible are not the same thing anymore. In my state, for example, there are no longer any HSA-compatible insurance plans but there are several high deductible ones.

That's unfortunate.

Re: The profit-obsessed monster destroying American emergency rooms

#149

Post by philwelch »

eadmund wrote: post #103
philwelch wrote: post #57

Earlier quoted context omitted.

I’ve long been a proponent of high deductible plans. The part you’re missing is that you also get the opportunity to contribute pre-tax money to a Health Savings Account, which is money that you get to keep (and even invest) over the long term. You can spend that HSA money on medical expenses but if you save it, it turns into another tax-advantaged savings account like your IRA and 401(k).

HSAs can be wonderful, but you absolutely have to have a good one. Some of them still pay less than 1% interest and charge monthly fees. The ones which can be invested and have no fees are an amazing savings tool.

This is true, but you can always roll over an HSA from a bad provider to a better one.

Re: The profit-obsessed monster destroying American emergency rooms

#150

Post by philwelch »

vundercind wrote: post #144
eadmund wrote: post #103

Earlier quoted context omitted.

HSAs can be wonderful, but you absolutely have to have a good one. Some of them still pay less than 1% interest and charge monthly fees. The ones which can be invested and have no fees are an amazing savings tool.

Indeed—the people who get by far the most benefit out of them are those who can afford to pay for everything without taking money out of the HSA, then claim those expenses much later in retirement (when you can also just start taking money out). To them, it’s another tax-advantaged retirement account, significantly raising their max annual contribution limits.

But--most importantly--it's a retirement account that you can spend early, if you have to, if you have unexpected medical expenses (which is the main reason an otherwise financially responsible person would have unexpected expenses). And in that scenario it's a much appreciated buffer for needing to withdraw money from another retirement account.

But frankly, even if you are spending the money on medical expenses in the same year, you're also getting a lot of benefit out of spending pre-tax rather than post-tax money.

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