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The anatomy of a ripoff

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Re: The anatomy of a ripoff

#161

Post by kenjackson »

CWuestefeld wrote: post #48
klenwell wrote: post #32

Earlier quoted context omitted.

I agree. I've been active in helping my grandparents manage their affairs the last few years and I find it interesting how frictionless it is for them, under the Kaiser HMO, to get medical services, especially prescriptions. I find it a little too frictionless at times. They sometimes show me the paperwork Kaiser gives them, but I don't remember ever seeing an itemized bill. I'd find it insightful, as I think they wo…

I'd also like them, and everyone (especially seniors), to see how much of those costs the government bears. At the risk of being pedantic, this is one case where one needs to remember that the government never bears any costs of anything. To the point: I'd also like them, and everyone (especially seniors), to see how much of those costs their fellow taxpayers bear.

Just curious, who is the government, if not your fellow taxpayers? I always assume the government are fellow taxpayers. A lot people seem to think government is some group of people they've never met that live in a far away land.

Re: The anatomy of a ripoff

#162

Post by krschultz »

goatforce5 wrote: post #106
wildmXranat wrote: post #86

Earlier quoted context omitted.

Huh ? I'm glad that your finger is better, but you procedure was not 'out-of-pocket' $0. Here in Canada, where the similar treatment would be $0 at the time of treatment, I would've paid in thousands already into the health care system in federal/provincial pay deductions. I consider, the money lost to be a continuous out of pocket expenditure. I still like this system more tbh.

The out-of-pocket was 0 in the sense that my tax is already paid and there was no additional expense in me choosing to go to hospital to be checked out. So, yes, I pay for it. A big chunk of my pay packet goes to tax, but i'm happy knowing I can receiving good treatment without having to work out if I can afford it. I'm also happy it means those less fortunate than myself (re: current income levels) will receive the…

And I really can't emphasize enough how much it sucks to do a cost/benefit analysis on going to the hospital or not. A couple of years ago my girlfriend and I were on crappy insurance (i.e. catastrophic coverage only) because that's all we could afford. She had a medium level concussion and we were debating the cost of going or not. Going and getting a cat scan was a sure way to spend $2,000 that we simply did not have. They might proscribe a painkiller, but otherwise she would sit around for a couple of days with a headache and be OK. If she didn't go to the hospital, there was a 99% chance that she would sit around and take advil and be OK. But there was that 1% lingering chance that it was worse than we thought and that not going was a horrible decision. We opted not to go to the hospital. It sucked worrying for days. Luckily she was ok in the end. But now that we have the means, my policy is that no matter what the cost, any recommended/optional healthcare gets paid for.

Re: The anatomy of a ripoff

#163

Post by Symmetry »

noonespecial wrote: post #135
furyg3 wrote: post #26

Earlier quoted context omitted.

> Medical care is the most highly regulated industry in the economy, and so nothing you see happening is going to bear very much resemblance to reality. This is a pretty big logical jump. I'm American, but have been living in the Netherlands for a while. Health care is probably more regulated here than in the US, yet in all of the ER visits I've experienced (myself or friends/family) I've never seen bills like that.…

"You can't jump half-way across a gorge". Letting it be free market wouldn't work nearly as badly as most people expect. "Socializing" medicine and making it a fully planned section of the economy wouldn't work nearly as badly as most people expect. Half-assing it between the two will work far worse than most people expect.

Well, there there are some places where the government messes about with the healthcare system about as much as we do, and it works out really well. Singapore for example http://en.wikipedia.org/wiki/Healthcare_in_Singapore

I think the main problem with the US healthcare system is that it's a elephantine monstrosity, a system that tries to hit every corner case with an ad hoc exception, and which nobody can understand more than a fraction of. And there are various boneheaded implementation details, the equivalent of bubblesort - like using the frigging labor theory of value to set physician reimbursement rates. And complex interdependancies that cause different parts of the system to affect each other for very non-obvious reasons. For instance, a rule to prevent people from defrauding Medicare now prevents corporations from giving free birth control to college students like they used to.

Re: The anatomy of a ripoff

#164

Post by [deleted] »

yummyfajitas wrote: post #104
jellicle wrote: post #99

Earlier quoted context omitted.

Well, yeah, if you ignore all the studies and only read libertarian blogs, then it's hardly clear. Administration accounts for 31% of healthcare costs in the U.S., and 16% in Canada, for example.

The views of the bloggers at the incidental economist tend to be moderate liberal. Seriously, go read the blog, and find me a single post indicating libertarian views. I'm sorry that data driven liberalism conflicts with mainstream ideology and your favored talking points.

[deleted]

Re: The anatomy of a ripoff

#165

Post by bzbarsky »

afterburner wrote: post #158
bzbarsky wrote: post #149

Earlier quoted context omitted.

The $5000 deductible is per year. Your typical decent high-deductible plan will have a $5000 deductible and 100% coverage thereafter until year end. The worst-case scenario with such a plan is that you end up with a chronic condition that requires extensive treatment every year, at which point it will cost you $5000 per year. Oh, and that's typically a per-family deductible, not per-person. Just to put that in perspe…

"that's typically a per-family deductible" A little better... "HSAs that automatically get money put into them every year for those who can't afford to do so " That's encouraging too, although I bet it doesn't refill at the same rate as topping it up yourself? I still think it's the wrong thing to do, though. I can appreciate the market pressure idea, but there are other ways to lower prices charged for procedures, a…

   That's encouraging too, although I bet it doesn't refill
   at the same rate as topping it up yourself?
No one is doing that sort of thing yet, so it's impossible to say how it would work if it were done.

I think we Americans have a pretty good idea of how much the current situation sucks. The issue people worry about has three aspects (in a very oversimplified view):

1) How do we make it not suck for individuals? 2) How do we, as a society, stop spending 16% of GDP (and climbing) on healthcare? 3) How do we avoid some sort of explicit rationing?

People's worries are that a lot of proposed solutions for #1 seem to imply giving up on #2 or #3. I suspect the worries about #3 are overblown, but it's hard to say without doing an experiment of course.

Luckily, perhaps, experimenting on humans is considered acceptable in politics. ;)

Re: The anatomy of a ripoff

#166

Post by [deleted] »

llimllib wrote: post #80
yummyfajitas wrote: post #63

Earlier quoted context omitted.

...when you measure things like life expectancy, Britons are as healthy as Americans. That gives you an idea of how much money is going down the tubes due to administrative inefficiency. It's hardly clear the money is going down the tubes due to administrative inefficiency. It might just be spent on unnecessary medicine, and costs might be higher in the US. According to one fairly decent source, administrative ineffi…

I'm also certain that much of the unnecessary medicine is provided because of the legal climate in the US; doctors practice under the assumption that they will be sued if they don't provide unnecessary medicine.

[deleted]

Re: The anatomy of a ripoff

#167

Post by asmithmd1 »

asmithmd1 wrote: post #138
turar wrote: post #122

I could never understand why there's such a huge financial difference in the way emergencies that threaten human lives are dealt with in the US. You never expect a huge bill from the fire department or the police department should you require their urgent help. How is ER different?

The US has socialized fire fighting and policing. We have decided not to socialize medicine.

This is absolutely true. Firefighting used to be handled by the private sector through insurance companies. This was "socialized" mainly because of the free rider problem - firefighters would put out a fire even if the house was Not insured. Now all houses in a town pay for firefighting through local taxes.

Re: The anatomy of a ripoff

#168

Post by [deleted] »

yummyfajitas wrote: post #104
jellicle wrote: post #99

Earlier quoted context omitted.

Well, yeah, if you ignore all the studies and only read libertarian blogs, then it's hardly clear. Administration accounts for 31% of healthcare costs in the U.S., and 16% in Canada, for example.

The views of the bloggers at the incidental economist tend to be moderate liberal. Seriously, go read the blog, and find me a single post indicating libertarian views. I'm sorry that data driven liberalism conflicts with mainstream ideology and your favored talking points.

[deleted]

Re: The anatomy of a ripoff

#169

Post by wisty »

fauldsh wrote: post #117
jbooth wrote: post #79

Earlier quoted context omitted.

A couple things, first off, if costs are higher in the US, they shouldn't be, we're not living in a radically different reality in the UK. Market forces should be lowering those costs, but they're not, because the actual cost centers are completely insulated from any market whatsoever by the insurance system. RE: administrative inefficiency, from my limited experience (laying off teachers in local gov't back in 2004…

One of the reasons it costs less in the UK is because the NHS bargains the costs of drugs (and machinery etc) it buys down. This works partially because they can and do refuse to buy the drugs deemed too expensive. I don't have any statistics to back this up, but because the US system ends up spending as much as the pharmaceutical companies can possibly charge meaning they pay more for the same drugs. Somewhat of a p…

Note the theory of second best - 2 monopolies (i.e. a union and the owner of a company town; or a health service and the monopoly owner of a patented drug) can negotiate a better and fairer deal than 1 monopoly and a fragmented party. 2 fragmented parties is best (in theory), but that doesn't always happen.

But most economists don't learn this in school. They just learn "monopoly = bad, government = monopoly".

Re: The anatomy of a ripoff

#170

Post by camiller »

goatforce5 wrote: post #53
jiggy2011 wrote: post #9

Wow , I'm glad I don't have to expend mental energy on stuff like this. Universal Healthcare, get it. It's really good. Honest.

Due to my own stupidity I fell off my bike on the weekend. A few minutes later I realised my little finger was swelling up and hurting a whole lot. Universal healthcare let me go to a hospital get 3 x-rays and a doctor to tell me nothing was broken. Took 3 hours, but multiple people apologised for it taking so long while I was there (to be honest, I thought it was quick. A sore finger must just about be last on the l…

I'm in the US. A few months ago I stood up into an open cabinet door and required twelve staples in my head. The (non-hospital) emergency medical facility charged me my $100 deductible and billed the remainder to my insurance. About three months later I got a letter apologizing for over billing, and a check for $50.

I don't expect thousands of dollars in bills in the future.

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