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The True Cost of Healthcare in the US

truecostofhealthcare.org

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Re: The True Cost of Healthcare in the US

#41

Post by adjwilli »

nirvana wrote: post #21

Back when he was alive, Milton Friedman did a study of the costs of health care in the US from 1900 to the 1970s. (I think the first study was in the 1970s, and it was updated in the 1990s) What he found was that the funding mechanism of health care over that time had shifted from patients paying out of pocket to government paying hospitals and government incentivized (by making it a tax write off for employers) and…

You're definition of socialism is a little funny. There's a big difference between socialized medicine as a single-payer system where the government has an incentive to keep costs low and a somewhat-centralized and somewhat-regulated system "socialized" system where the government has no such incentive.

Re: The True Cost of Healthcare in the US

#42

Post by lotharbot »

ambiate wrote: post #4
jneal wrote: post #3

Earlier quoted context omitted.

I suppose you are prepared to starting paying the tax penalty for not having insurance under the PPACA?

If necessary, I will pay the penalty. I assume the credit for health care costs and taxes charged on health care should make up for any penalties incurred by the PPACA. If I read correctly, my penalty should only be $950-1300. Inevitably, with my insurance rates, I would spend that on 2 months of health coverage for my small family. Just to break down costs: $600/mo health for wife/kid. $7200/yr. vs ~200/mo + 1000 pe…

You don't need to have traditional "insurance" to be exempt from penalty under PPACA.

There are exemptions for members of certain groups (IIRC, Native American tribes and religious groups that are opposed to the concept of insurance, like the Amish). There are also exemptions for participants in "health cost sharing ministries" [0]. My family pays $135/month for what, practically, functions like a high-deductible plan [1] -- a little more expensive than just paying the penalty, but it's worth it to mitigate the cost risk associated with catastrophic illness.

[0] http://en.wikipedia.org/wiki/Health_care_sharing_ministry . There's a list of Christian health-sharing ministries at http://www.healthcaresharing.org/ ; I don't know what other religions or non-religions might have similar programs.

[1] the friend who referred me to this signed up for a no deductible option. He was diagnosed with cancer a month later, and they covered everything.

Re: The True Cost of Healthcare in the US

#43

Post by larrywright »

nirvana wrote: post #21

Back when he was alive, Milton Friedman did a study of the costs of health care in the US from 1900 to the 1970s. (I think the first study was in the 1970s, and it was updated in the 1990s) What he found was that the funding mechanism of health care over that time had shifted from patients paying out of pocket to government paying hospitals and government incentivized (by making it a tax write off for employers) and…

One of the ideas I've heard discussed is that the only way we will ever get the cost of health care down is if consumers are back in the drivers seat with how the dollars are spent. Right now it's disconnected. I go in to have something done, the doctor bills my insurance company, and I really don't know (or care) how much it costs, unless I happen to look at the insurance paperwork. The same goes for pharmaceuticals. Which pharmacy in your town has the lowest price on that antibiotic that was just prescribed for your son's ear infection? Who cares, right? It's a $15 co-pay no matter where you go, so you go wherever is most convenient.

One solution that's been proposed is the increased use of HSAs + high deductible policies. That way people are paying their expenses out of pocket (for the day-to-day things at least), and are therefore more likely to shop around.

I'm not hear to argue the merits of that, but it definitely seems like an approach that might work. I fail to see how anything that takes control out of the hand of the individual will fix this problem (short of regulating the prices, which I wouldn't be a fan of).

Re: The True Cost of Healthcare in the US

#44

Post by smutticus »

nirvana wrote: post #21

Back when he was alive, Milton Friedman did a study of the costs of health care in the US from 1900 to the 1970s. (I think the first study was in the 1970s, and it was updated in the 1990s) What he found was that the funding mechanism of health care over that time had shifted from patients paying out of pocket to government paying hospitals and government incentivized (by making it a tax write off for employers) and…

>Whenever someone talks about the need for socialized medicine because "otherwise people would go bankrupt", remember it is the socialization of medicine that caused costs to rise to the point where people would go bankrupt.

Because there are thousands of Canadians every year that go bankrupt because of health care costs. Your argument doesn't even begin to make sense.

Re: The True Cost of Healthcare in the US

#45

Post by bdesimone »

danielweber wrote: post #18
bdesimone wrote: post #13

I haven't read the whole site yet but I jumped to the topic I know fairly well, medical malpractice. Just some additional notes to consider: * 9 out of 10 physicians would discourage their children from becoming doctors.[3] There are many reasons for this. Malpractice insurance premiums are a factor. Not the only factor. * California physicians have the lowest insurance premiums in the country. This is directly the r…

Richard Thaler just had this op-ed in the NYT on ways to reduce costs, talking some about tort reform: http://www.nytimes.com/2013/02/24/business/overcoming-obstac... ; I'm skeptical about tort reform as a panacea. However, lawsuits are incredibly expensive, and so doctors take steps that we would otherwise call economically unreasonable to avoid them. The amount of tort reform I think is really necessary is whatever…

It's not a panacea. It's a part of the very complicated system that is providing and paying for healthcare. How important are insurance premiums relative to other factors? It depends. But there are costs to having uncapped settlements, and lack of tort reform.

Also, insurance premiums effect practices of different sizes differently. I personally think you can attribute the shift away from smaller private practice groups towards larger groups and hospitals are for other reasons. Insurance premiums are somewhat to blame, but I think the bigger driver is that many of the government mandates are too expensive (n.b. this doesn't mean it shouldn't be done) to take on for most smaller private practice groups.

I'm not sure how to respond to your comment about tort form if it get's us to an NHS like system, because I disagree that's the best way forward. But that's a topic for another day.

Re: The True Cost of Healthcare in the US

#46

Post by nicholasjarnold »

huhsamovar wrote: post #14

I am one of the lucky few who has insurance provided by their employer. Unfortunately, if I am in a car accident and rack up $100,000 in bills, I am bankrupt.

> Unfortunately, if I am in a car accident and rack up $100,000 in bills, I am bankrupt.

...or you just have to haggle with the hospital and refuse to pay their grossly inflated funny money prices.

I have a good friend who incurred 30K in bills for a 2 day stay related to a broken femur. He has no insurance. Since seeing his bill, which wasn't itemized at all, he's basically refusing to pay anything until he sees what he's being charged for. In response to this demand the hospital reduced his bill by about 12K, magically, and still providing no itemization.

He is still refusing to pay and only time will tell what the outcome will be. It's very clear, however, that he was grossly overcharged and that the hospital has no clue what they're really billing for. It's a game. Some people roll over, others fight.

If someone really ends up with 100K+ in medical bills after adjustments then it might actually make sense to take 7 years of 'bad credit' after a bankruptcy. No easy answers here, but it's pretty clear we're all being swindled.

Re: The True Cost of Healthcare in the US

#47

Post by elemeno »

cpeterso wrote: post #27

Do other countries have employer-funded health insurance? Why doesn't my employer pay for, say, my car insurance? This system discourages people from leaving a job to start their own business because private health insurance can be very expensive.

In the UK, it's not unusual for employers to offer private health insurance (or at least, it's pretty common for profesional jobs - I can't comment for other types of jobs!). From their point of view, it's comparatively inexpensive and the cost is probably easy recouped from their employees being able to get health problems dealt with faster than they might on the NHS so they're off work for less time.

Edit - Given that we've got the NHS as well, losing your private coverage isn't such a big deal. It's nice to have, not a must have.

Re: The True Cost of Healthcare in the US

#49

Post by noahc »

cdavid wrote: post #37
nirvana wrote: post #21

Back when he was alive, Milton Friedman did a study of the costs of health care in the US from 1900 to the 1970s. (I think the first study was in the 1970s, and it was updated in the 1990s) What he found was that the funding mechanism of health care over that time had shifted from patients paying out of pocket to government paying hospitals and government incentivized (by making it a tax write off for employers) and…

There is an easy way to refute your argument: what you're saying about 'socialization' also happened in most developed countries. At least in France, so-called 'social security' (which is about mandatory health insurance, and not pension as in the US) came in place just after WW 2, and without the US insanity in price inflation. Comparing with 1900 prices is a bit of nonsense given that there was little surgery at th…

He is comparing prices by putting it into 2013 dollars. It has nothing to do with availability. You can take a car, computer, or any other good that has a price and easily convert it back to 1865 or 1900 or whatever dollars and this helps understand the cost of things relative to today.

This makes your two middle paragraphs irrelevant.

If you want to just look at cancer here is a place to start: http://www.cancer.org/cancer/cancerbasics/economic-impact-of...

Much of the health care costs in America are generated by major medical issues. I've recently seen a number released by my insurance provider that said that 7% of those who use them for insurance generate 90% of the claims by dollar amount. The thing is, no one knows when they will be in the 7%.

Re: The True Cost of Healthcare in the US

#50

Post by skylan_q »

smutticus wrote: post #44
nirvana wrote: post #21

Back when he was alive, Milton Friedman did a study of the costs of health care in the US from 1900 to the 1970s. (I think the first study was in the 1970s, and it was updated in the 1990s) What he found was that the funding mechanism of health care over that time had shifted from patients paying out of pocket to government paying hospitals and government incentivized (by making it a tax write off for employers) and…

>Whenever someone talks about the need for socialized medicine because "otherwise people would go bankrupt", remember it is the socialization of medicine that caused costs to rise to the point where people would go bankrupt. Because there are thousands of Canadians every year that go bankrupt because of health care costs. Your argument doesn't even begin to make sense.

Because there are thousands of Canadians every year that go bankrupt because of health care costs.

Actually, there are. They go the US to get care that's not offered in Canada. The care here is about as good as former soviet bloc countries. If there was a chance that an illness such as cancer could kill me, I'd get out of Canada in a heartbeat and embrace poverty if it meant keeping my life.

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