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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#171

Post by twodave »

mjevans wrote: post #161
ChadNauseam wrote: post #150

Earlier quoted context omitted.

It interacts badly with insurance being offered as workplace benefit. If you quit or lose your job, you'd lose your health insurance. And any plan you signed up for after that would then treat you as "pre-existing embers" and expect you to pay accordingly. The bundling of health insurance with workplace seems like the healthcare original sin to me. Obama couldn't change that, so the ACA redesigned the system to work…

The US is allergic to taxes. Maybe it's a marketing thing. Benefits paid for by society. Maybe a department of Return on Investment. See what those taxes pay for. Contrast to buying private versions of the services at the same SLA or better.

It’s more that the US is more like a collection of 50 little countries, and it’s supposed to be hard to accomplish much at a federal level. That separation has eroded a bit in the last 50 years but it’s still very much a part of our political ideology.

Re: The American Healthcare Conundrum

#172

Post by bloppe »

bandofthehawk wrote: post #159
cj wrote: post #149

Earlier quoted context omitted.

Some quick googling suggested cashiers at Seiyu in Japan earn $7-9/hour USD while Walmart is about double that.

If the Japanese cashier makes half the amount, but spends only 1/3 on healthcare that still seems to favor Japan

Well sure, then you're kinda cherry picking data that could easily be considered within a margin of error to make a rather unconvincing point

Re: The American Healthcare Conundrum

#173

Post by throw0101c »

twoodfin wrote: post #137
ipsento606 wrote: post #85

Earlier quoted context omitted.

> ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions people have forgotten how bad things used to be

Why is that inherently bad? Should I be able to buy fire insurance on pre-existing embers?

> Why is that inherently bad? Should I be able to buy fire insurance on pre-existing embers?

What if someone gets Type 1 diabetes as a child so they can no longer get insurance because of that "pre-existing" condition: if they get cancer for unrelated reasons they should just be saddled with medical debt? Or because of your Type 1 you can't get coverage, and you get t-boned in your car by a drunk driver.

Certainly it sounds 'unfair' that someone who smokes (a personal choice) gets similar cancer coverage for someone who does not smoke. But it also means that if your ((great-)grand-)mother had cancer, and you get it through no fault/choice of your own (i.e. genetics), you can also get coverage. (This latter effects a cousin of mine: her aunt (mom's sister) died of cancer at 37, her mom at 63; so now she's wonder when here number will come up. We're in Canada, so have universal care, but it's still something in her DNA.)

There are many circumstances in which you suffer through no fault of your own, and universal health coverage is present in many societies because it was decided to protect those people—even if it allows some 'free-riding' by others making poor choices.

People make all sorts of crazy decisions to prevent the "wrong" people from getting what they "don't deserve":

* https://en.wikipedia.org/wiki/Dying_of_Whiteness

Re: The American Healthcare Conundrum

#174

Post by ajkjk »

twoodfin wrote: post #137
ipsento606 wrote: post #85

Earlier quoted context omitted.

> ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions people have forgotten how bad things used to be

Why is that inherently bad? Should I be able to buy fire insurance on pre-existing embers?

it's bad for the person, obviously. The point of society-wide policies is not to maximize economic efficiency; they're supposed to making society a good place to live. Of course if you only look at them under an economic lens they're going to seem bad. Economically the best policy would be to kill all the sick people.

Re: The American Healthcare Conundrum

#175

Post by Spooky23 »

phil21 wrote: post #20
timtim51251 wrote: post #7

Lots of people are saying nonsense here. The actual reason commercial insurers pay more is that's the only way to can make more profits. Because of Obamacare requiring 80% of the money they collect to be spent, the insurance companies just get to keep 20%. So insurance companies spend more so they can collect higher premiums. That's how they make more money. Several doctor friends have told me this as well.

In a vacuum sure. But insurance companies operate the only part of the healthcare system that is moderately competitive. In the end employers are the ones largely paying and they are professional negotiators enough to put price pressure on insurance plans. 20% of $0 is $0. As such, as light of an incentive it is - it’s the only party in the entire system that is incentivized in any way whatsoever to keep costs down.…

They really aren’t. They package benefits to try to hit different price points. Obamacare accelerated consolidation of providers and most regions have a cartel of 2-4 health networks.

Re: The American Healthcare Conundrum

#176

Post by autoexec »

rayiner wrote: post #41
phil21 wrote: post #35

Earlier quoted context omitted.

Insurance is really not the issue, it’s provider cost. And just the total cost entirely of the system of insanity. If you look closely into it there is no single (or few even) knobs you can tweak to fix the system. Not even Medicaid for all, at least as it’s currently designed. No argument from me that insurance is not competitive enough. But they are almost all public corporations that are highly regulated so the nu…

Trying to understand why healthcare in the U.S. is so expensive is like trying to understand why building subway in New York is so expensive: https://www.nytimes.com/2017/12/28/nyregion/new-york-subway-... . The issues lend themselves to facile explanations ("insurance companies are greedy," "NYC's government is wasteful") but those are driven by ideology not analysis.

What we can say for certain is that heath insurance companies in the US stuff their pockets with tens of billions in profits each year and that Americans are paying far more while getting less for their money than other developed nations. I don't think those two things are unrelated.

Re: The American Healthcare Conundrum

#177

Post by raw_anon_1111 »

SV_BubbleTime wrote: post #168
raw_anon_1111 wrote: post #19

Earlier quoted context omitted.

So I happen to be in Costa Rica for the month. Just like every other 1st world country, it has managed to have universal health care that is better and cheaper without private insurance. Even if you do get private insurance for quicker access, it’s still much cheaper than the US. I just spoke to someone who flew down here to save $30K on dental work. The problem isn’t the ACA, it’s the ass backwards American health c…

Costa Rica is a beautiful country. But it is in no way “first world”. It has no military, and is effectively dependent of the US and in best cases neighboring countries. It has excellent weather and soil which account for its fruits exports… and outside of some niche industry, is mostly reliant on tourism which means importing money. I love that country and have been many times. But if it were god forbid wiped off th…

Costa Rica purposefully got rid of its military so it could provide services. It didn’t feel a need to fund three unnecessary wars in two years.

Guess which other country has universal healthcare - China. They are just slightly more populous than the US.

> This isn’t some mechanism that the US just refuses to use. It’s a matter of scale. You either don’t know and should remain silent on the topic, or do know it and lack the honor to not state it.

China does have a military…

Maybe you should take your own advice. Every other country in the world seems to have figured this out.

Re: The American Healthcare Conundrum

#178

Post by Spooky23 »

bsjshshsb wrote: post #143
CGMthrowaway wrote: post #92

Earlier quoted context omitted.

Digi is correct here. >For example Cigna requires all maintenance medication be purchased through express scripts Important note: Cigna owns Express Scripts. Today the biggest "insurance" companies are actually massive conglomerates that own the clinics, the doctors and the pharmacies. United = Optum. Aetna = CVS + Caremark. Humana = CenterWell. Elevance/Blue Cross/Anthem/Carelon. Centene = Envolve Once a giant like…

Why wasn't it set up so the government is the insurer. Rather than 3rd partying it. It is akin to federal reserve using wells fargo to store their money.

Because that is evil socialism

Re: The American Healthcare Conundrum

#179

Post by conductr »

kstrauser wrote: post #167
conductr wrote: post #51

Medicare prices are too low to operate on. They generally factor in the bare minimum or slightly less for the variable costs of a procedure but severely under value the fixed costs of providing the same procedure. So those costs largely get pushed to commercial payors as those are the only ones who can shoulder it. There’s plenty of arguements about waste and executive compensation but when I was a healthcare CFO we…

Sure you’re not thinking of Medicaid? Medicare was generally pretty good for reimbursement. When my wife treated Medicaid patients, she often lost money on the cost of the supplies used to treat them, let alone rent and paying the staff etc etc. Most doctors who see Medicaid patients do it as basically pro bono. Some figured out how to game the system with economies of scale but it’s nearly impossible do do and maint…

Medicaid is usually a big loss for hospitals. It’s just a cost of doing business and another reason why someone else has to pay more. It’s completely a subsidy essentially. This is why certain areas only have a county hospital, it’s likely the same area that is a food desert and has no retail banks, the simple truth is too high of a Medicaid mix will quickly sink a for profit hospital.

Medicare is as I described. Every specialty and procedure has its quirks though, some even make a killing on Medicare and not commercial but the hospital kind of represents a portfolio and the overarching economics in aggregate favor the commercial insurance. I’m guessing your wife’s specialty had decent Medicare rates but it’s not always true.

There’s even some private insurance which is effectively Medicare that has different reimburse ranges (Medicare advantage plans).

Executives like to lament the lose money on Medicare but I never really saw it that way. If you look at it isolated, sure it’s true. But if you look at it as a portfolio where your fixed costs are covered by another cohort, then it’s a huge volume to add and make money at the contribution profit line. You just have to be careful not to run fixed costs as a percentage of total revenues or something like that. The extra volume Medicare brings to a hospital or network of hospitals also has tremendous negotiating power for pharma, medical supplies and devices, etc.

Re: The American Healthcare Conundrum

#180

Post by GenerWork »

raw_anon_1111 wrote: post #152
twoodfin wrote: post #137

Earlier quoted context omitted.

Why is that inherently bad? Should I be able to buy fire insurance on pre-existing embers?

If you live long enough, you will have a pre existing condition. The way it was suppose to work with the original mandate is that everyone had to be insured either through their employee or the exchange. So you couldn’t just buy insurance when you were sick. The Supreme Court struck that down. If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insu…

>If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insurance at any cost.

This is a flat out lie. You absolutely could buy health insurance without being at a company.

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