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  #251  
Old 09-27-2019, 03:51 PM
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Originally Posted by k9bfriender View Post
Question about how that all played out.

I assume that the doctors were not doing this out of the goodness of their hearts, that they were getting paid, correct?

And the insurance company gets to choose what doctors that they want to use to get a third party opinion on a procedure correct?

Do you think that insurance companies would send it to doctors who have a higher or a lower rate of approving suspect procedures?

Do you think that the doctors would feel any pressure to err on the side of denying claims in order to continue getting these referrals?
AFAIK, it's a mandated thing in the occ health insurance world, so the real trick is finding the one that was at the right price point and who can handle your case volume within whatever your regulatory agency's time frames are. I don't know that the determination rates are public knowledge; at any rate, the real concern was that they stayed consistent, not that they were particularly low or high.

In general, the occ health world is rife with fraud; that's another reason for these third party reviews; it gives the insurance company another layer of protection from some jackass doctors who are using their patients to try and milk the system by doing unnecessary treatments or very costly procedures without actually trying more conservative stuff first.

Remember- there's usually not a dramatic amount of discretion on these- there are treatment guidelines, the doctors read them, and then look at the case, and decide whether the treatment(s) adhere to those guidelines or not.

Here's an example of a case:

Patient presented with knee pain after a slip & fall. Initial treating physician diagnosed a knee sprain (S83.402A), with edema and pain. Treating physician prescribed rest, immobilization and 80 mg oxycontin.

The triage nurse at insurance company or third-party administrator would look at that and think "Hmm... oxycontin for a knee sprain? And 80 mg? That's for opioid resistant patients." So they'd put it out for third-party review.

Reviewer gets the case, and reads the facts of the case. He reads the relevant treatment guidelines for a knee sprain of that type and severity, and notes that it calls for rest, ice, immobilization and something like 400mg of naproxen. He calls the treating physician to ask him why he prescribed oxycontin. Now at this point, it could go different ways- if the treating physician says something like "Well, last time she had an NSAID, she went into anaphylactic shock, Tylenol isn't very effective, and she's a opioid addict, so there wasn't much else I could do", then the reviewer might certify it. But if the treating physician says something less than kosher, or he can't get hold of the treating physician, he probably won't certify it.

I want to point two things out here- first, the point isn't to deny claims as such, but rather to identify situations where the treatment given doesn't conform to accepted treatment guidelines- for example, homeopathy would probably never get certified if used in a worker's comp context. Second, this is all done under the auspices of an accreditation body to ensure independence and fairness.

Last edited by bump; 09-27-2019 at 03:52 PM.
  #252  
Old 09-27-2019, 03:55 PM
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Originally Posted by Linden Arden View Post
I agree with this but I ask you -

How can my (or any worker) cost be LESS when you add 120 million people to those of us who currently pay all the Medicare taxes?
Well, theres many ways to do it. Here is one of the simplest: Medicare currently spends roughly 700 billion to pay for, I think it is 55 million people. Medicaid spending is about 600 billion. So 85 % of Medicare. If these people are all being put on Medicare, it seems excessive to also have Medicaid for them.

Now unlike the people already on medicare, the 120 million are under-65s, and therefore on the average far cheaper. By a factor of 4.

In total, for 600 billion you should then be able to add 55 x 4 x 0.85 = 187 million of the younger and healthier general population. This is, as you will have noticed, about half again the number of people it has been proposed to add, so there is considerable savings.
  #253  
Old 09-27-2019, 04:34 PM
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Why is everyone missing the obvious math here?

Even if your Medicare taxes double -- even if they triple -- you still probably come out ahead because you no longer have to pay for private health insurance. Plus no longer having to worry about losing your coverage if you lose your job, etc etc etc.
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  #254  
Old 09-27-2019, 04:50 PM
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Why is everyone missing the obvious math here?

Even if your Medicare taxes double -- even if they triple -- you still probably come out ahead because you no longer have to pay for private health insurance. Plus no longer having to worry about losing your coverage if you lose your job, etc etc etc.
And I just saw this: Health Insurance Costs Surpass $20,000 Per Year, Hitting a Record

Will your Medicare taxes really exceed $20,000 a year?
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  #255  
Old 09-27-2019, 06:15 PM
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Why is everyone missing the obvious math here?

Even if your Medicare taxes double -- even if they triple -- you still probably come out ahead because you no longer have to pay for private health insurance. Plus no longer having to worry about losing your coverage if you lose your job, etc etc etc.
These are some of the obvious points that the pro-insurance types like the OP seem to be totally missing. The other point that they always miss is the following: "Bureaucracy in the health care system accounts for about a third of total U.S. health care spending -- a sum so great that if the United states were to have a national health insurance program, the administrative savings alone would be enough to provide health care coverage for all the uninsured in this country, according to two new studies".

So that's how you can add on all the presently uninsured and still come out ahead. When you have UHC for everyone, you don't have actuaries setting rates and bureaucrats adjudicating claims: everyone pays the same, everyone gets full coverage, and no one is denied. Sounds "too good to be true", but that's demonstrably how single payer actually works. In effect, you come out ahead because you're not paying insurance bureaucrats to interfere with your health care -- one of the sad ironies of private insurance in American health care.
  #256  
Old 09-28-2019, 12:52 AM
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...so this happened to me yesterday (in humble New Zealand).

I went to see my cardiologist. 3 years ago I had a Pulmonary Embolism (PE). Damn near killed me. I saw him regularly after the PE, then every two months, and now I see him every six months, they do an echocardiogram and a consult. My cardiologist tells me the echo results look good.

Cost out of pocket? $4.00 for a car-park.

I tell my cardiologist that this week was a bit unusual and I was struggling with my breathing. He tells me to take an urgent blood test, just in case, which I do.

Cost out of pocket? Zero.

I hop in the car and drive home. I get out of the car and the phone rings. Its my GP. Well, not quite my GP as my GP is on holiday. Its the GP who was covering the other GP's work. On a Friday, at 4PM. He tells me that the levels of whatever it was the blood test was testing for was elevated, and recommended that I urgently report to the Emergency Department for more testing. And he asked if I needed an ambulance to transport me in.

How much would it cost me out-of-pocket for an ambulance? Zero.

I declined, and (against doctors orders) I drove myself in. It took me minutes to get triaged, then a couple of hours before I was faced with a battery of tests. They all came up clean, but they wanted to do a CT scan to be sure. It was late at night, there wasn't any urgency, so the scan was scheduled for the next day, and they sent me to stay in a ward overnight.

Cost out of pocket for all of this? Zero.

I had come of the warfarin a couple of years ago, and it didn't look like I had PE, but they started me on clexane anyway, just to be safe.

Cost out of pocket for two doses of clexane? Zero.

This morning came along. I had the CT scan. A doctor reviews the results, no PE. I finish eating my hospital-provided-lunch and drive myself home.

How much did the CT scan cost me out of pocket? Zero. How much did parking in the hospital overnight cost me? Zero: because I was an overnight-emergency patient I was given a parking voucher.

And this, in a nutshell, are the fundamentals of a Universal Healthcare System. Each country that has UHC do it slightly differently, but they are all predicted on the following principals:

Its a system for delivering healthcare. Not basic healthcare for everyone and full healthcare for those who have more money. It just healthcare.

Its universal. Everyone is covered. Everyone has access. Nobody misses out.

Over the last ten years my family has had to access the healthcare system more times than I really would have liked for non-serious things and for complex life-threatening things, and the treatment I got today was the same treatment my family got, my friends have gotten, that I got three years ago when I first went into hospital. This isn't extraordinary service, this is just how UHC works.

And it isn't easier to set up UHC in a country like New Zealand with a smaller population. We don't have the same economies of scale the United States has, we don't and can't match your GDP, we are on the ass-end of the world and its harder for us to (generally) do stuff than it is in the US.

Yet we have universal healthcare.

So lets bring this back to the OP. The OP won't vote for someone who will "take (their) family's insurance away". Without context this sounds like a reasonable fear.

But the context is important. I feel that we no longer need to cite the fact that the US government spends more on healthcare per capita than anywhere else in the world. Then on top of that you've got people paying (the same amount again) in insurance, with companies contributing as an 'incentive', the US outspend the rest of the world by a fuck-ton amount of money.

In UHC countries the principle is simple: we provide healthcare for everyone.

The OP holds the principle "I've got mine. That's all I care about."

But I'm not sure I've got that correct though.

So to the OP: if the United States of America could start from scratch, if it were to re-write its healthcare system with universality at its core, that might result in an increase in taxes but virtually eliminate the need for you (or your employers) to pay for health insurance (leading to an overall reduction in costs), would you be willing to have your "health insurance taken away" if it meant that your neighbour would be able to get access to the same level of health care that you have?
  #257  
Old 09-28-2019, 01:02 AM
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Yes, I'm really curious about the OP's concern. The title of this thread suggests he's afraid his family will lose health insurance, but he's never elaborated on why he thinks that, and hasn't explained why he thinks his health insurance now is better than UHC. His concern seems to be taxes going up.

I'm really curious to know what kind of coverage he has and why he thinks it's better than a UHC model.

Glad to hear you're okay, Banquet Bear!
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  #258  
Old 09-28-2019, 11:08 AM
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Possible rationale:

Taxes are bad. You are taking my money
Government is inefficient. Always. The private sector is better. Always.
America is unique. You can't compare it to other countries with UHC
I don't want to pay for those undeserving people's healthcare (for various definitions of "undeserving")

This seems to sum up the main arguments I've heard from folks who oppose UHC in the United States.
  #259  
Old 09-28-2019, 12:26 PM
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@ Linden Arden - Simple question: Suppose you know that the Democrat "wants" to take away your family's insurance, but ALSO know that Congress will not approve of this, and that you WILL retain that insurance, at least for the next several years.

Given those stipulations would you still vote for Trump?


Quote:
Originally Posted by Linden Arden View Post
... MFA will ADD 120 million people to our payroll tax burden. I expect my cost to double based on current law. Yet I have a lying politician who claims my "cost" will go down by adding those 120 million people. And she won't provide any detail to support such an outlandish claim.

Trump has lied some 12,000 times according to the Washington Post. But he hasn't told one that big yet.
You seem to think that the funding for M4A will come out of the present Medicare payroll tax. I do not believe any politician supports that. The funding will come from corporate taxes, the progressive income tax, and perhaps wealth taxes. Sure, people who have income above some high level will end up losing money on M4A (at least before savings kick in) but whatever gave you the idea that the funding will come from payroll taxes?

And, whether or not you will like paying those higher taxes on your very high income, where do you get off calling a Senator Warren (or is it Sanders?) a liar? Even implying that she's a worse liar than Donald Trump??
  #260  
Old 09-29-2019, 01:50 AM
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Glad to hear you're okay, Banquet Bear!
...thank-you
  #261  
Old 09-29-2019, 02:14 AM
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How much did the CT scan cost me out of pocket? Zero. How much did parking in the hospital overnight cost me? Zero: because I was an overnight-emergency patient I was given a parking voucher.
Excellent post, Banquet Bear, and I suggest that everyone read it in its entirety because stories like that happen all over the world every day, where health care is a service available to all as a matter of principle, delivered at little or no cost to the individual. I'm just amused about the parking voucher -- here in Canada hospitals are a lot more mercenary, perhaps because of the geographical proximity to the mercenary US health care system; not being allowed to extort patients for health care services, hospitals extort them for parking! An overnight stay in ER would have cost me anywhere from $15 to $25 for parking, though of course zero for actual health care.

I had an experience similar to yours a couple of years ago, which I won't repeat in detail because I think I've talked about it before. I drove myself to the ER as a precaution because I'd been having chest pains for several days. I left some wine and cheese on the counter figuring I'd be back in a couple of hours at most. It was five days before I was back because it turned out I was having a heart attack! The two basic messages I want to leave here about that are these:
  • Various procedures were considered including the recommendation of bypass surgery -- the classic open-heart surgery -- or stenting (PCI) instead. The important thing here is that medical considerations and my own preferences were the only criteria -- costs were irrelevant, nor was any consideration of what would be "covered", because there was no insurance company involved, only a universal health care system.
  • The entire experience did not cost me one dime. Nothing. Literally zero.*

* Just don't ask about the parking cost! I should have taken an ambulance, for which the maximum out of pocket cost is $40.
  #262  
Old 09-29-2019, 04:09 PM
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Originally Posted by bump View Post
AFAIK, it's a mandated thing in the occ health insurance world, so the real trick is finding the one that was at the right price point and who can handle your case volume within whatever your regulatory agency's time frames are. I don't know that the determination rates are public knowledge; at any rate, the real concern was that they stayed consistent, not that they were particularly low or high.

In general, the occ health world is rife with fraud; that's another reason for these third party reviews; it gives the insurance company another layer of protection from some jackass doctors who are using their patients to try and milk the system by doing unnecessary treatments or very costly procedures without actually trying more conservative stuff first.

Remember- there's usually not a dramatic amount of discretion on these- there are treatment guidelines, the doctors read them, and then look at the case, and decide whether the treatment(s) adhere to those guidelines or not.

Here's an example of a case:

Patient presented with knee pain after a slip & fall. Initial treating physician diagnosed a knee sprain (S83.402A), with edema and pain. Treating physician prescribed rest, immobilization and 80 mg oxycontin.

The triage nurse at insurance company or third-party administrator would look at that and think "Hmm... oxycontin for a knee sprain? And 80 mg? That's for opioid resistant patients." So they'd put it out for third-party review.

Reviewer gets the case, and reads the facts of the case. He reads the relevant treatment guidelines for a knee sprain of that type and severity, and notes that it calls for rest, ice, immobilization and something like 400mg of naproxen. He calls the treating physician to ask him why he prescribed oxycontin. Now at this point, it could go different ways- if the treating physician says something like "Well, last time she had an NSAID, she went into anaphylactic shock, Tylenol isn't very effective, and she's a opioid addict, so there wasn't much else I could do", then the reviewer might certify it. But if the treating physician says something less than kosher, or he can't get hold of the treating physician, he probably won't certify it.

I want to point two things out here- first, the point isn't to deny claims as such, but rather to identify situations where the treatment given doesn't conform to accepted treatment guidelines- for example, homeopathy would probably never get certified if used in a worker's comp context. Second, this is all done under the auspices of an accreditation body to ensure independence and fairness.
Right, if that's your experience with how claims work in the US for a government paid system (I assume that's the case for occupational health and worker's comp claims), I understand your earlier post about how you think a UHC system would operate similarly.

'cept it ain't so.

As wolfpup and I have pointed out, in a UHC system cost control is done by the initial determination of how much the Medicare system will pay for each procedure. After that, it's left to the professional judgment of each doctor. There's no internal review or case-by-case treatment protocols like you describe here.
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Last edited by Northern Piper; 09-29-2019 at 04:10 PM.
  #263  
Old 09-29-2019, 07:33 PM
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Originally Posted by bump View Post
At that point, he needs to go back to the ER doctors and sue them for negligence or malpractice if they diverged from the accepted treatment guidelines. One way or another, either the ER docs or the insurance company reviewer fucked up, and he needs to get that straightened out.

Quote:
Originally Posted by Horatius View Post
...because the one thing you really need after major surgery is an extremely complicated, probably years-long lawsuit involving multiple possible defendants, and all their lawyers, who are all pointing the blame at the other people.

As one of our Dopers has found out the hard way:

Where's davidm? In hospital recovering from a medical screw-up

He's been careful not to talk on the boards about the details of any discussions he's had with lawyers, but has mentioned the medical bills, both from the initial treatment and the follow-up treatment for the treatment.

It shouldn't be the case that someone who is going through a lengthy convalescence of over a year should simultaneously be worrying about paying the medical bills and dealing with lawyers to ensure the medical bills get paid. But, that seems to be the system of health "insurance" that Americans have and (at least some) defend.

And that doesn't mean there's no remedy for medical malpractice in countries with UHC. There certainly is. But, what you're suing for is the damage caused by the medical screw-ups. You're not suing to get coverage for the medical treatment for the screw-up.

(And, I would encourage any American who's happy with their insurance to read davidm's tale about how his "insurance" has worked.)
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  #264  
Old 09-30-2019, 08:55 AM
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Converse to Banquet Bear:
Pay for medical insurance through my government employer, $375/mo.
Have polycystic kidney disease. Rupture a cyst, extreme pain, go to ER: $125 out of pocket.
Get follow up bill for $460 for random testing while in hospital for 4 hours. Oh, and $20 parking fee.
Multiple nephrologist appointments: $50/each.
Fistula placement for dialysis: $200 out of pocket, after $75 surgery appointment fee.
Dialysis: After arguing with my insurance provider, pay $50 per treatment / $150 per week. They wanted to charge the surgery appointment fee of $75 per treatment.
After three months, am eligible for Medicare Parts A/B as secondary insurance. Enroll. No more dialysis fees, no more doctor appointment fees; however, I pay $145 every three months for Medicare on top of the $375/mo insurance.
(Note: all through this I'm also paying approximately $150/mo out of pocket for prescriptions)
Discover kidney foundation will pay my Medicare fees. Sweet! Whenever I get the bill, I give it to the financial counselor at dialysis and they pay it.
After three years on dialysis, Medicare becomes my primary insurer, employer insurance becomes my secondary insurer.

Fast forward to June 2019:
Discover the financial counselor at dialysis has NOT been paying Medicare. Medicare terminated as of 06/01/19.
June 20th, get "The Call" for a new kidney. June 21st, have surgery.
Starting the following Monday, I'm back at the hospital daily for blood testing. The following week, blood testing is twice per week. There's also multiple Dr's visits. Each time, I pay $8 to park.
August 9th, spent four hours at the local Social Security office, reapplying for Medicare parts A/B, as allowed by the government (kidney transplant recipients are eligible for Medicare for three years).

As of today, I have over $80K in bills sitting on my table, as Medicare and my employer based insurance will not pay until Medicare decides whether I'm eligible for part B (Part A was immediately approved to pay for the actual transplant and hospital stay). Those daily to biweekly blood tests? $2k/each. I've spent over 20 hours on the phone with providers, my employer insurance and Medicare. I am now receiving threatening phone calls and my credit has been dinged.

I have no idea whether Part B will be approved, it's still pending. If it's not approved, my employer insurance has a $5k yearly deductible. And now I'm paying over $200/mo for prescriptions (which ONE of my anti-rejection drugs retails for over $7k/mo, so I can't complain too much)
  #265  
Old 09-30-2019, 09:06 AM
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To x-post something I wrote in another thread. T'was a lot of work, so...

Quote:
Originally Posted by JohnT View Post
Mathematically: Insurance is a pooled risk program. For the insureds, the pool works better the larger it is and the more representative of the population of a whole. In the arena of health care, where there does seem to be a general consensus towards the necessity of universal health insurance coverage (100% of the population covered), having private insurance breaks these pools apart, decreasing their financial stability, increasing the costs on the enrollees, and imposes additional costs by the duplication of effort - from staff to executive - needed to run 6+ major insurance organizations instead of 1.

Personal: Delores Claireborne works at The Texas Mental Health Association, a non-profit which is the major mental health services provider for a three-county area in Texas centered around Cotulla. Delores gets paid 26 times per year, has 1 child, and per her divorce agreement from that drunken bastard, has to provide the child with health insurance.

Delores has the following employee+child options (Plan, per paycheck cost, annual premium, deductible, Out of Pocket Max, amount paid out of pocket before insurance covers 100% of medical expenses)

1. High Deductible, $234.06, $6,085.56, $5,000.00, $5,000, $11,085.56)
2. Medium Deductible, $295.34, $7,678.84, $2,500, $5,500, $13,178.84)
3. Low Deductible, $362.57, $9,426.82, $1,000, $4,000, $13,426.82)

Oh, in addition to this, her employer covers $4,919.78 for her medical and life insurance. Group life is $20/month/enrollee (it's cheap), so the employer pays, in addition to the 2nd item in each of the rows above, $4,679.78.

Total cost of insurance if Delores never goes to the doctor and has the cheapest plan: $10,765.34 ($6,085.56 out of Delores's pocket)
Total cost of insurance if Delores has $5,000 of expenses: $15,765.34 ($11,085.56 out of Delores's pocket)
Total cost of insurance if Delores has $700,000 of expenses: $15,765.34 ($11,085.56 out of Delores's pocket)

Median household income in Cotulla is $34,567 - Delores earns $40k pre-tax, $37,500 after tax.

Out of pocket health insurance premium as a % of take-home income: 16.22%
Out of pocket health insurance as a % of take-home income, assuming Delores hits the out of pocket max: 29.56%

Notes:

1. These are real numbers. Names are made up, I mixed and matched clients, we do business in Cotulla but not with anything called "Texas Mental... whatever". But the numbers are real.
2. This is, in no way, unusual for small business group medical insurance rates for the state of Texas.
3. The employer is rather generous here - they effectively pay for the employees insurance*, meaning this is the cost to cover her 1 child.
4. The most expensive plan: $763.20 per pay period, $19,843.20, annually for employee, $24,522.98 total annual premium

The above is repeated... 4.7 million times... across Texas.

That's my argument against.
*The minimum an employer must contribute is 50% of the premium of the lowest-cost offered employee-only plan. So if there's one "we don't cover anything, but if you get in a situation where you have to pay $800k, you'll be glad your max out of pocket was just $7,900" plan for, say, $249/month, in Texas, the employer can offer a mere $125/month in benefit contribution to each and every employee and still be in compliance. If you need a $6,000 emp+child plan, in this situation your employer can pay $1,500 and you pay $4,500. Just for the insurance!

Last edited by JohnT; 09-30-2019 at 09:08 AM.
  #266  
Old 10-01-2019, 11:39 AM
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Originally Posted by Banquet Bear View Post
So to the OP: if the United States of America could start from scratch, if it were to re-write its healthcare system with universality at its core, that might result in an increase in taxes but virtually eliminate the need for you (or your employers) to pay for health insurance (leading to an overall reduction in costs), would you be willing to have your "health insurance taken away" if it meant that your neighbour would be able to get access to the same level of health care that you have?
I'm not the OP, but the premise of your question is flawed. We would still have to pay for health insurance no matter what system we have. The question is how we pay for it, either funded strictly through federal taxes or funded through premiums that come from multiple sources. If funded through single-payer, I'm still paying because I pay taxes.

And then, if we did switch to single-payer, i.e. Medicare for All, would the nation save money or spend more money? On that question, there are a wide variety of opinions. Economists and think tanks from the right and left have to make rough assumptions and those assumptions lead to different views on whether single-payer will save money or cost more money. See attached from the NY Times, where they compared a handful of cost estimates, some which forecast more cost, not less, if we go to Medicare for All. The Urban Institute is left-leaning for instance, and they think it will cost more:

https://www.nytimes.com/interactive/...estimates.html

But in any event, back to your question, I support a more robust ACA. From that more robust ACA, I expect my taxes to go up, and I don't think I will save anything on my own employer-provided policy. However, it helps get more people insured, and I'm willing to do that. IMO, that's selfless, because I'm not getting any benefit from it myself.
  #267  
Old 10-01-2019, 11:52 AM
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Originally Posted by wolfpup View Post
Excellent post, Banquet Bear, and I suggest that everyone read it in its entirety because stories like that happen all over the world every day, where health care is a service available to all as a matter of principle, delivered at little or no cost to the individual.
Oh yes, there is a cost to the individual. If they're a taxpayer, there's a cost to them. If we get Medicare for All in the US, we will have a cost.

Also, as I posted in response to BB, there's also great divergence in the cost estimates of medicare for all. The costs might actually be more under single-payer in the US than under current law:

https://www.nytimes.com/interactive/...estimates.html

And these estimates aren't from Donald Trump lovin' right-wing economists. Some of these guys are left-of-center and not averse to the idea of government-provided UHC.
  #268  
Old 10-01-2019, 11:59 AM
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But in any event, back to your question, I support a more robust ACA. From that more robust ACA, I expect my taxes to go up, and I don't think I will save anything on my own employer-provided policy. However, it helps get more people insured, and I'm willing to do that. IMO, that's selfless, because I'm not getting any benefit from it myself.
Not directly, and not at the moment, at least. But, a robust ACA, and good, affordable individual insurance, would still be a benefit for you -- it'd give you the assurance that, if you ever lose your job, or wind up working for yourself (or for a smaller company that doesn't offer health coverage), that you'll still have health insurance. It also potentially means that you won't feel like you *must* stay in a job you don't like, because you need to keep your health insurance.

Last edited by kenobi 65; 10-01-2019 at 12:04 PM.
  #269  
Old 10-01-2019, 12:01 PM
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And then, if we did switch to single-payer, i.e. Medicare for All, would the nation save money or spend more money?
Presumably the nation would have to go through a process of deciding what it wants to pay for, and what it's willing to pay for it - and attempting to reconcile the two by one means or another. It can't be beyond the wit of man, or woman.
  #270  
Old 10-01-2019, 12:12 PM
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Not directly, and not at the moment, at least. But, a robust ACA, and good, affordable individual insurance, would still be a benefit for you -- it'd give you the assurance that, if you ever lose your job, or wind up working for yourself (or for a smaller company that doesn't offer health coverage), that you'll still have health insurance. It also potentially means that you won't feel like you *must* stay in a job you don't like, because you need to keep your health insurance.
OK, I see that point. But keep in mind that the main benefit from a well-functioning ACA is for society as a whole, especially for people who are poor, working/middle-class who don't have employer health insurance, or people have pre-existing conditions. These people would all benefit much more from the ACA than I will. My most likely outcome is almost no change to my status, except maybe I pay more in taxes.
  #271  
Old 10-01-2019, 12:16 PM
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Presumably the nation would have to go through a process of deciding what it wants to pay for, and what it's willing to pay for it - and attempting to reconcile the two by one means or another. It can't be beyond the wit of man, or woman.
Right. And reasonable estimates have said we will pay more than we currently pay. We can't just assume authoritatively that the US will save money with single-payer. If only it were that simple.
  #272  
Old 10-01-2019, 01:13 PM
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Right. And reasonable estimates have said we will pay more than we currently pay. We can't just assume authoritatively that the US will save money with single-payer. If only it were that simple.


But here's the thing: even if it cost you more, it would be worth it. Because "costs" include more than just the money out of your pocket.

No one would lose their insurance because they lost their job.

No one would lose their insurance because their company went bankrupt.

No one would lose their insurance because they decided to quit their job to start a new job, or run their own business.

No one would have to worry about coverage being denied.

No one would have to worry about going to the "wrong" doctor or hospital when they're having an emergency.

No one would have to worry about covering "co-pays" or "deductibles" which might run into the thousands of dollars.

No one would have to worry about finding out the plan you chose years ago doesn't cover the medical problems you've developed today.

Those costs, and more, would simply go away.
  #273  
Old 10-01-2019, 06:25 PM
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@ Linden Arden - Simple question: Suppose you know that the Democrat "wants" to take away your family's insurance, but ALSO know that Congress will not approve of this, and that you WILL retain that insurance, at least for the next several years.

Given those stipulations would you still vote for Trump?
I'm unsubscribing from the thread. Anyone: Please PM me if OP ever answers my question.
  #274  
Old 10-01-2019, 06:46 PM
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But here's the thing: even if it cost you more, it would be worth it. Because "costs" include more than just the money out of your pocket.

No one would lose their insurance because they lost their job.

No one would lose their insurance because their company went bankrupt.

No one would lose their insurance because they decided to quit their job to start a new job, or run their own business.

No one would have to worry about coverage being denied.

No one would have to worry about going to the "wrong" doctor or hospital when they're having an emergency.

No one would have to worry about covering "co-pays" or "deductibles" which might run into the thousands of dollars.

No one would have to worry about finding out the plan you chose years ago doesn't cover the medical problems you've developed today.

Those costs, and more, would simply go away.
Well yes, obviously.

But I don't know those people, and probably would not like them anyway; they are probably undeserving. (for various definitions of "undeserving")
  #275  
Old 10-01-2019, 06:54 PM
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Right. And reasonable estimates have said we will pay more than we currently pay. We can't just assume authoritatively that the US will save money with single-payer. If only it were that simple.
That's certainly a fair comment. The US spends more per capital on health care now than any other country. While UHC provides lower cost in other countries, that higher US cost is currently "baked in" to the US health care system. Even with administrative efficiencies from UHC, it can take a while for systemic costs to drop.
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  #276  
Old 10-01-2019, 07:21 PM
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I'm not the OP, but the premise of your question is flawed. We would still have to pay for health insurance no matter what system we have. The question is how we pay for it, either funded strictly through federal taxes or funded through premiums that come from multiple sources. If funded through single-payer, I'm still paying because I pay taxes.

And then, if we did switch to single-payer, i.e. Medicare for All, would the nation save money or spend more money? On that question, there are a wide variety of opinions. Economists and think tanks from the right and left have to make rough assumptions and those assumptions lead to different views on whether single-payer will save money or cost more money. See attached from the NY Times, where they compared a handful of cost estimates, some which forecast more cost, not less, if we go to Medicare for All. The Urban Institute is left-leaning for instance, and they think it will cost more:

https://www.nytimes.com/interactive/...estimates.html

But in any event, back to your question, I support a more robust ACA. From that more robust ACA, I expect my taxes to go up, and I don't think I will save anything on my own employer-provided policy. However, it helps get more people insured, and I'm willing to do that. IMO, that's selfless, because I'm not getting any benefit from it myself.
...compare and contrast:

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Originally Posted by Banquet Bear View Post
Cost out of pocket? $4.00 for a car-park.

...

Cost out of pocket? Zero.

...

How much would it cost me out-of-pocket for an ambulance? Zero.

...

Cost out of pocket for all of this? Zero.

...

Cost out of pocket for two doses of clexane? Zero.

...

How much did the CT scan cost me out of pocket? Zero. How much did parking in the hospital overnight cost me? Zero: because I was an overnight-emergency patient I was given a parking voucher.
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Originally Posted by MissTake View Post
C
As of today, I have over $80K in bills sitting on my table, as Medicare and my employer based insurance will not pay until Medicare decides whether I'm eligible for part B (Part A was immediately approved to pay for the actual transplant and hospital stay). Those daily to biweekly blood tests? $2k/each. I've spent over 20 hours on the phone with providers, my employer insurance and Medicare. I am now receiving threatening phone calls and my credit has been dinged.
I've got Universal Health Care. Myself and my family have universal coverage for healthcare based entirely on the fact that I live in New Zealand and I pay my taxes.

I've got no skin in the game. I'm entirely convinced that if you really wanted too, the most powerful and one of the richest nations in the entire history of the world could set up a Universal Healthcare system that would cost people substantially less out-of-pocket than it does at the moment. And even if America couldn't (through sheer incompetence) make a system that would be cheaper, it could make a system that was universal.

So don't debate me. I know it can work. All of us that don't live in America? We know it works.

I didn't share my personal story here for purposes of debate. I shared it here to show you that it can be done. My story wasn't exceptional. It was boringly normal. This is what living under Universal Healthcare is like. You will get the same stories all around the world.

So don't debate me. Your job isn't to convince people like me that you are right. You have to convince people like MissTake or Broomstick that whatever plan you have is better than a universal one. They have skin in the game. They are at the mercy of their employers, of the insurance companies, of government bureaucracy. You explain to them how you plan to fix things.

I honestly hate this. I hate that this is even a debate. The system that you have, the way that you treat people, is disgustingly inhumane. As I said earlier in the thread: Universal Healthcare is premised on two things: one it is universal, and two that it provides healthcare. If your plan for fixing the US healthcare system isn't based on those two fundamental premises then it is guaranteed not everyone will have coverage. Strengthening the ACA will still mean millions of people won't be able to access the healthcare system. It will still mean we hear stories of people with over $80K in bills. That face medical bankruptcy. Don't worry about arguing with me. What are you going to say to them?
  #277  
Old 10-01-2019, 07:52 PM
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...
So don't debate me. I know it can work. All of us that don't live in America? We know it works.

I didn't share my personal story here for purposes of debate. I shared it here to show you that it can be done. My story wasn't exceptional. It was boringly normal. This is what living under Universal Healthcare is like. You will get the same stories all around the world.

So don't debate me. Your job isn't to convince people like me that you are right. You have to convince people like MissTake or Broomstick that whatever plan you have is better than a universal one. They have skin in the game. They are at the mercy of their employers, of the insurance companies, of government bureaucracy. You explain to them how you plan to fix things.

I honestly hate this. I hate that this is even a debate. The system that you have, the way that you treat people, is disgustingly inhumane. As I said earlier in the thread: Universal Healthcare is premised on two things: one it is universal, and two that it provides healthcare. If your plan for fixing the US healthcare system isn't based on those two fundamental premises then it is guaranteed not everyone will have coverage. Strengthening the ACA will still mean millions of people won't be able to access the healthcare system. It will still mean we hear stories of people with over $80K in bills. That face medical bankruptcy. Don't worry about arguing with me. What are you going to say to them?
The NZ Healthcare system is totally irrelevant to whether or not your question was based on a wrong premise. The US system, if we go to single-payer, has a non-negligible likelihood (according to healthcare economists) of costing more than it does now. Don't dismiss these estimates, because there is real thought and educated assumptions behind it. And the taxpayers, including me, will be paying for it, whether it costs more or less. We're talking about the US system, which is based on US laws, US politics, and expectation of the voters, doctors, lawyers, hospitals, dems, pubs, you name it. We're not talking about the NZ system.

I am willing to pay more taxes to insure that the US gets to UHC without losing my current policy. I'll get nothing for it, except I'll pay more taxes, and keep what I have. That's as selfless as a person can be.
  #278  
Old 10-01-2019, 08:17 PM
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The NZ Healthcare system is totally irrelevant to whether or not your question was based on a wrong premise.
...my question wasn't based on a false premise.

Quote:
The US system, if we go to single-payer, has a non-negligible likelihood (according to healthcare economists) of costing more than it does now.
Quote:
Originally Posted by my premise
So to the OP: if the United States of America could start from scratch, if it were to re-write its healthcare system with universality at its core, that might result in an increase in taxes but virtually eliminate the need for you (or your employers) to pay for health insurance (leading to an overall reduction in costs), would you be willing to have your "health insurance taken away" if it meant that your neighbour would be able to get access to the same level of health care that you have?
I stand by my premise. My premise is based on starting from scratch, re-writing its healthcare system with universality at its core.

Quote:
Don't dismiss these estimates, because there is real thought and educated assumptions behind it.
I don't give a fuck about those estimates. They aren't relevant to my point.

Quote:
And the taxpayers, including me, will be paying for it, whether it costs more or less.
AS THEY SHOULD.

Quote:
We're talking about the US system, which is based on US laws, US politics, and expectation of the voters, doctors, lawyers, hospitals, dems, pubs, you name it. We're not talking about the NZ system.
The US system is fucked up. US laws are fucked up. US politics are royally fucked up. The expectations of voters, doctors, lawyers, hospitals, dems, pubs, you name it, are set by people who are invested in maintaining the status quo.

Quote:
I am willing to pay more taxes to insure that the US gets to UHC without losing my current policy. I'll get nothing for it, except I'll pay more taxes, and keep what I have. That's as selfless as a person can be.
Then explain to MissTake how you intend to rid them of their 80K debt. Explain how you get to UHC without actually embracing the fundamental premise of UHC, which are universality and healthcare.
  #279  
Old 10-01-2019, 08:25 PM
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The NZ Healthcare system is totally irrelevant to whether or not your question was based on a wrong premise. The US system, if we go to single-payer, has a non-negligible likelihood (according to healthcare economists) of costing more than it does now. Don't dismiss these estimates, because there is real thought and educated assumptions behind it. And the taxpayers, including me, will be paying for it, whether it costs more or less. We're talking about the US system, which is based on US laws, US politics, and expectation of the voters, doctors, lawyers, hospitals, dems, pubs, you name it. We're not talking about the NZ system.

I am willing to pay more taxes to insure that the US gets to UHC without losing my current policy. I'll get nothing for it, except I'll pay more taxes, and keep what I have. That's as selfless as a person can be.
But your current policy is shit. I don't know the specifics, but I know the industry, and your policy is 3rd-rate compared to what they have in New Zealand. Australia. Japan. Britain. France. Germany. Canada. And more.

So, why the need to keep a crap-assed policy?

And if you claim it's not shit, tell us your plan design, costs (copays, deductibles, max out of pocket, annual employee-paid premium, and employer-paid premium), and more.

Because even the best plans nowadays, even for the largest companies, have devolved to the lowest common denominators. And what that means is you will be out of pocket thousands of dollars before the insurance company picks up a damned dime. And this is by design.

Last edited by JohnT; 10-01-2019 at 08:26 PM.
  #280  
Old 10-02-2019, 06:32 AM
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I'm not the OP, but the premise of your question is flawed. We would still have to pay for health insurance no matter what system we have. The question is how we pay for it, either funded strictly through federal taxes or funded through premiums that come from multiple sources. If funded through single-payer, I'm still paying because I pay taxes.
Well, no. It is not given that you'd have to pay for health insurance. You'd have to pay for health care. Its not the same thing, and the difference has a bit to do with the cost differences. And your taxes already pay more for healthcare than an average UHC system for your population costs.

Quote:
Originally Posted by survinga View Post
And then, if we did switch to single-payer, i.e. Medicare for All, would the nation save money or spend more money? On that question, there are a wide variety of opinions.
There may be a wide variety of opinions, but there is plenty of practical experience, and no variety there: It is universally cheaper than what you currently do by a very large margin. Always. No variety there.
The laws of economics do not respect variety of opinion. The laws of economics do not care what think tanks say. The laws of economics do not pay attention to differing views. The laws of economics do not think you are special.

If you end up with a more expensive system it will be for one reason and one reason only: It was designed to be more expensive by people who wanted to benefit from that. Corruption, in other words. Regulatory failure.
  #281  
Old 10-02-2019, 08:43 AM
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I honestly hate this. I hate that this is even a debate. The system that you have, the way that you treat people, is disgustingly inhumane. As I said earlier in the thread: Universal Healthcare is premised on two things: one it is universal, and two that it provides healthcare.
I hate it, too. Speaking as an American, I'm appalled that we (en masse) can't seem to understand that health care should be included in:

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."

We're far too focused on pulling the ladder up after ourselves. I'm embarrassed for us all. We continue to be a nation of selfish hypocrites (as a group).
  #282  
Old 10-02-2019, 12:14 PM
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...

I don't give a fuck about those estimates. They aren't relevant to my point.


Those estimates are VERY relevant to your point. You are making an assumption about the costs incurred in our healthcare system in your originally flawed question, and I'm telling you that people who know much much more about US healthcare than you or me don't agree with you, or at best have a mixed opinion.

You can throw out the F word. But those estimates are relevant whether you like it or not, because those estimates are about the US. And they are much more relevant than anything about the healthcare system of a country that has less population than Metro Atlanta.
  #283  
Old 10-02-2019, 12:25 PM
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If you end up with a more expensive system it will be for one reason and one reason only: It was designed to be more expensive by people who wanted to benefit from that. Corruption, in other words. Regulatory failure.
I don't care what the reason is. Talk to the cost estimates:

https://www.nytimes.com/interactive/...estimates.html

These people know more about healthcare in the US than you, me, Wolfpup, Banquet Bear, and Bernie put together.
  #284  
Old 10-02-2019, 12:30 PM
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You are citing one article which belabors the obvious point that giving people with little to no access to coverage/care in the current system greater access to care in a revised system will make overall costs go up.

So... yeah. So what?
  #285  
Old 10-02-2019, 12:41 PM
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Would like to note the article completely ignored savings brought about by:

1. Reduced staff on the part of doctors and hospitals, especially those dealing with insurance issues (compliance, billing, claims, accounting, more)
2. Greatly reduced complexity in billing
3. Lack of commissions being paid to insurance sales people ($25 per month per insured here in the TX small business market. 4.7 million employed by small bus, assume 30% are covered, this would be a $423 million savings in the TX small business health insurance market alone.)

... more.
  #286  
Old 10-02-2019, 12:54 PM
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Would like to note the article completely ignored savings brought about by:

1. Reduced staff on the part of doctors and hospitals, especially those dealing with insurance issues (compliance, billing, claims, accounting, more)
2. Greatly reduced complexity in billing
3. Lack of commissions being paid to insurance sales people ($25 per month per insured here in the TX small business market. 4.7 million employed by small bus, assume 30% are covered, this would be a $423 million savings in the TX small business health insurance market alone.)

... more.
I don't think they fully account for the savings to employees & employers from not needing to buy insurance either. It seems to be looking mainly at costs to the government.
  #287  
Old 10-02-2019, 12:59 PM
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I don't care what the reason is. Talk to the cost estimates:

https://www.nytimes.com/interactive/...estimates.html

These people know more about healthcare in the US than you, me, Wolfpup, Banquet Bear, and Bernie put together.
Why is the Urban Institute analysis in that article the gold standard, or are you just illustrating the worst case? Friedman shows a substantial savings while Mercatus and RAND show very little change in costs compared to the current.

Bottom line, nobody really knows what will ultimately happen, but it's pretty clear that the status quo is untenable for the reasons listed by Horatius. More, the things that this money is actually spent on would be more directly related to health care, and not to support the bureaucracy and profits of the health insurance industry.
  #288  
Old 10-02-2019, 01:02 PM
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I'm still interested in your plan design, btw.

Insurance Company:
Plan Name:
Deductible:
Max Out of Pocket:
Per-Paycheck Cost to You:
Number of times paid per year:
Cost to your employer (express per check, annually, whatever - just let me know the period the number refers to):
Employer Size (# of employees):
ACA plan (Y/N):
Do you have out of network benefits?:

Really, if you could just link to me your summary of benefits (it will look like this), that would be cool. It won't have the cost info, but it will have all the rest. Then I can do a financial analysis of your policy (I already have the spreadsheets set up) to see when you get 1st-dollar benefits beyond copays. I'll even find out how much you have to incur in medical expenses before you receive more in benefits than you paid out.

Thanks!
  #289  
Old 10-02-2019, 01:24 PM
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I don't think they fully account for the savings to employees & employers from not needing to buy insurance either. It seems to be looking mainly at costs to the government.
No, they include premiums, that's stated earlier. But the composition of those premiums includes such things as commissions and the SG&A (Selling, General, and Administrative) expenses related to having a sales team.

In short: Remove the sales team and you're probably removing $500 of cost, per month, per enrollee, from the health care system.

So, using Texas figures (which I know best)...

28.7 million people
- 5 million without health insurance
-----
23.7 million enrolled

23,700,000 X 25 X 12 = $7,110,000,000

Assume health insurance will be $400 per person per month (look at my Delores Clairborne example above)...

$400x12=$4,800

$7,110,000,000/4,800 = 1,481,250

Just by removing commissions alone, an additional 1.5 million people can gain health insurance in the state of Texas.

Now that we've removed the S, let's look at the G&A side...

I'm not going into detail, but let's be assured that in my experience G&A should take about 14-18% of revenue, which is buttressed on page 14 of this PDF.

So... 14% of revenue. Let's see how that shakes out:

28.7 million people
- 5 million without health insurance
-----
23.7 million enrolled

Assume health insurance will be $400 per person per month (look at my Delores Clairborne example above)...

23,700,000 X 400 X 12 = $113,760,000,000

$113.76 billion X 14% = $15,926,400,000 (That's $672 in sales overhead, per person, per year!)

$15,926,400,000/$4,800 = 3,318,000 additional insured

----

# insured because no commissions: 1,481,250
+# insured because no G&A caused by sales overhead: 3,318,000
=# insured because health insurance was socialized, eliminating sales agents and the support staff needed for them: 4,799,250

# of people in Texas uninsured: 5,000,000

But, obviously, somebody writing for the New York Times knows more about this than me.

Last edited by JohnT; 10-02-2019 at 01:29 PM.
  #290  
Old 10-02-2019, 01:31 PM
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One thing about the above I didn't explain: In small group health insurance in the State of Texas, commissions are a flat $25 per insured per month, no negotiation. When you get larger groups (50+) you can negotiate, but things tend towards the mean here, guys.
  #291  
Old 10-02-2019, 01:49 PM
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Why is the Urban Institute analysis in that article the gold standard, or are you just illustrating the worst case? Friedman shows a substantial savings while Mercatus and RAND show very little change in costs compared to the current.

Bottom line, nobody really knows what will ultimately happen, but it's pretty clear that the status quo is untenable for the reasons listed by Horatius. More, the things that this money is actually spent on would be more directly related to health care, and not to support the bureaucracy and profits of the health insurance industry.
The Urban Institute isn't the gold standard. But people on this board take it as gospel that single-payer will save money. And I think that type of groupthink needs to be challenged, because the opposite could very well be true. What is often cited are savings in admin & claims adjusters. But we don't know what M4A will be forced to pay doctors, pharmaceutical companies, hospitals, & surgery/outpatient centers. Nor do we know what will occur with patient behavior. Others, including me, have pointed out corruption and politics, which could make the design of an M4A system as expensive, inefficient, and kludgy as anything else. So, we shouldn't be making these grand assumptions about cost savings & single payer. It might evaporate before our eyes.
  #292  
Old 10-02-2019, 01:51 PM
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"Remove the sales team and you're probably removing $500 of cost, per month, per enrollee, from the health care system."

Uh.... no idea where that $500 figure came from. The actual $ is $80. I think I originally guessed "50" when I wrote it and typed in an extra 0, never going back to modify it when I was done with the math.
  #293  
Old 10-02-2019, 01:52 PM
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The Urban Institute isn't the gold standard. But people on this board take it as gospel that single-payer will save money. And I think that type of groupthink needs to be challenged, because the opposite could very well be true. What is often cited are savings in admin & claims adjusters. But we don't know what M4A will be forced to pay doctors, pharmaceutical companies, hospitals, & surgery/outpatient centers. Nor do we know what will occur with patient behavior. Others, including me, have pointed out corruption and politics, which could make the design of an M4A system as expensive, inefficient, and kludgy as anything else. So, we shouldn't be making these grand assumptions about cost savings & single payer. It might evaporate before our eyes.
But "making grand assumptions" is the entirety of your argument up to the sentence about not "making grand assumptions."

I asked for... and provided... numbers. Can you do the same, or are you going to let the NY Times do your math for you?
  #294  
Old 10-02-2019, 02:04 PM
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Originally Posted by JohnT View Post
But "making grand assumptions" is the entirety of your argument up to the sentence about not "making grand assumptions."

I asked for... and provided... numbers. Can you do the same, or are you going to let the NY Times do your math for you?
The NYT isn't doing the math for anyone. They're just summarizing 5 separate studies, of which 3 think we will have higher healthcare costs post-single-payer. I think that carries more weight to the general public than anything posted on this board by you, me, or people in Canada and New Zealand.

Last edited by survinga; 10-02-2019 at 02:05 PM.
  #295  
Old 10-02-2019, 02:08 PM
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Originally Posted by survinga View Post
The Urban Institute isn't the gold standard. But people on this board take it as gospel that single-payer will save money. And I think that type of groupthink needs to be challenged, because the opposite could very well be true. What is often cited are savings in admin & claims adjusters. But we don't know what M4A will be forced to pay doctors, pharmaceutical companies, hospitals, & surgery/outpatient centers. Nor do we know what will occur with patient behavior. Others, including me, have pointed out corruption and politics, which could make the design of an M4A system as expensive, inefficient, and kludgy as anything else. So, we shouldn't be making these grand assumptions about cost savings & single payer. It might evaporate before our eyes.
This is a much more nuanced response than I have been seeing upthread, underscoring the uncertainty of these analyses. You have been harping on the most pessimistic analysis. Most of your interlocutors, it seems to me, have been struggling to emphasize the uncertainty and point out that ultimately, the shift in costs, good or bad, will happen regardless, because the current situation is unacceptable.

Will I ultimately pay more in a National Health Tax than I and my employer are currently paying to United Health Insurance? Will my doctor have to take a pay cut, or can she recover that through a lower overhead burden by not needing to employ as many office staff? The reply is hazy; please try again after a formal plan is introduced. I'm just going to figure that there will be growing pains and unintended consequences regardless of the actual plan, but also that ultimately, the majority of the country will be more secure in not having to worry about a loved one's illness destroying their household, not just the body.
  #296  
Old 10-02-2019, 02:15 PM
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Originally Posted by survinga View Post
The NYT isn't doing the math for anyone. They're just summarizing 5 separate studies, of which 3 think we will have higher healthcare costs post-single-payer. I think that carries more weight to the general public than anything posted on this board by you, me, or people in Canada and New Zealand.
Yes, we know your beliefs. I want to know your math.

Give me the numbers. Let me figure this out for you, then you can make an educated decision based upon your numbers and not what some rando quoted by a single newspaper said.
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Old 10-02-2019, 02:25 PM
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Originally Posted by SingleMalt View Post
This is a much more nuanced response than I have been seeing upthread, underscoring the uncertainty of these analyses. You have been harping on the most pessimistic analysis. Most of your interlocutors, it seems to me, have been struggling to emphasize the uncertainty and point out that ultimately, the shift in costs, good or bad, will happen regardless, because the current situation is unacceptable.
I think I've been consistent in what I'm saying. And even if you don't think so, just look at the groups doing these estimates in the NYT. They are not a bunch of CATO or Heritage think tank types. This isn't Fox News. I think the NY Times is more than fair to candidates like Bernie, Warren, or any other democrat who wants Single-Payer. In the face of these estimates, I take with a grain of salt the dominant position on this board about how M4A will "save money".
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Old 10-02-2019, 02:32 PM
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This argument seems to pit math, logic and factual analysis against a belief system. Some folks here believe that costs would not go down in a UHC system, because..... reasons. Because they believe they might not.

And the belief system will win every time. Because it's impossible to get someone to change a belief system using math, logic and factual analysis.

Last edited by Euphonious Polemic; 10-02-2019 at 02:33 PM.
  #299  
Old 10-02-2019, 03:00 PM
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Originally Posted by survinga View Post
The Urban Institute isn't the gold standard. But people on this board take it as gospel that single-payer will save money. And I think that type of groupthink needs to be challenged, because the opposite could very well be true. What is often cited are savings in admin & claims adjusters. But we don't know what M4A will be forced to pay doctors, pharmaceutical companies, hospitals, & surgery/outpatient centers. Nor do we know what will occur with patient behavior. Others, including me, have pointed out corruption and politics, which could make the design of an M4A system as expensive, inefficient, and kludgy as anything else. So, we shouldn't be making these grand assumptions about cost savings & single payer. It might evaporate before our eyes.
What is going to "force" M4A to pay a particular fee for those services when one of its major features is that it sets those fees? To be sure, there will be providers caterwauling about losing their sacred right to set their own fees, but as I said earlier, all health care systems have cost controls; you either control provider costs up front through a negotiated uniform fee structure, impacting the providers' economic autonomy, or you do it by meddling in the doctor-patient relationship, impacting the providers' clinical autonomy which ought to be recognized as much more important, and which insurance companies are constantly violating in the course of normal business. Furthermore, the fees are not set unilaterally by the single payer program, but are negotiated with the physicians' professional association, and they would surely accept lower fees knowing that their net income will remain about the same and that they will be relieved of massive amounts of paperwork and costs while being guaranteed prompt full payment.

You keep alluding to how smart the folks are who costed out M4A, but another group that's pretty smart is the group of folks who run all the UHC programs all over the world, and specifically in the industrialized OECD countries, and every single one of them without exception costs far less than the US system, averaging less than half as much per capita. It's absurd to claim without evidence that the US is somehow fundamentally different because it's inherently more corrupt, or bigger, or can't manage anything properly or something.

I'm not sure what you mean by "patient behavior", but I assume it's a reference to potential over-utilization if individuals have no cost constraints to utilizing medical services. This is just silly, because it doesn't happen in other countries, including places where there is no co-pay for anything. It doesn't happen because no one considers a visit to the doctor or to the hospital to be a form of entertainment. They do it because they have to, because they need medical attention. What does happen is that people don't unduly put off doctor's visits or surgical procedures for financial reasons, causing their conditions to worsen and making treatment more difficult and expensive, so it actually promotes a healthier population while helping to reduce costs.

We've been going round and round on this forever. I'll just say that the underlying factor here that we're all subject to, including me, is that we have a natural reluctance to change a system that we feel we're generally pretty happy with, especially when it's an important benefit like health care. But ISTM that my reluctance -- and that of my fellow posters in other single-payer type UHC countries -- is far more objectively justified than Americans' reluctance to part with private insurance. Why on earth would I give up a health care system that pays for all the health care I need, never costs me anything out of pocket, never requires me to do any paperwork, never denies a claim, allows me to see any health care provider I choose, and overall costs half as much per capita as the US private insurance system? And why on earth would anyone prefer and cling to the latter?
  #300  
Old 10-02-2019, 03:44 PM
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Originally Posted by wolfpup View Post
What is going to "force" M4A to pay a particular fee for those services when one of its major features is that it sets those fees? To be sure, there will be providers caterwauling about losing their sacred right to set their own fees, but as I said earlier, all health care systems have cost controls; you either control provider costs up front through a negotiated uniform fee structure, impacting the providers' economic autonomy, or you do it by meddling in the doctor-patient relationship, impacting the providers' clinical autonomy which ought to be recognized as much more important, and which insurance companies are constantly violating in the course of normal business. Furthermore, the fees are not set unilaterally by the single payer program, but are negotiated with the physicians' professional association, and they would surely accept lower fees knowing that their net income will remain about the same and that they will be relieved of massive amounts of paperwork and costs while being guaranteed prompt full payment.
And, it's not like fee-setting isn't going on *today* in the U.S. Not only does CMS set the fees for treatment for people who are currently covered by Medicare, but private health insurance companies are setting fees with providers who are "in network" for them.

Undoubtedly, in both cases, it's some manner of a collaborative process between the providers and the insurers, but in the end, I suspect that it's the insurers who hold most of the power in that fee-setting -- meaning that, even today, the providers don't necessarily have a great deal of control over their fees, while, at the same time, the providers' billing systems need to be able to cope with multiple insurance company systems.
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