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  #51  
Old 08-02-2019, 01:51 PM
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Originally Posted by Bone View Post
People who are 70 can still pay for insurance, if they choose. They don't have to pay for Medicare.

In any event, I think people should pay commensurate with their risk. If you have a group of low and high risk people, creating a separate risk pool for each would yield lower and higher costs, respectively. Blending them into a single risk pool would yield somewhere in the middle. Disallowing people to opt out of the combined pool and form their own low risk pool means that those in the lower risk pool would pay more than they otherwise would.
Any pooling at all is people not paying commensurate to their risk. You will never have two people with exactly the same risks of health costs, much less a "pool". What you are advocating is getting rid of pooling altogether, and just paying it all on your own.

Otherwise, why should I, a 25 year old non-smoker with great genes who never does anything dangerous, pay for you, a 25 year old non-smoker with simply okay genes who occasionally goes for a hike at the local park(where you could have tree branch fall on you, or you could slip down a ravine)?

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Originally Posted by UltraVires View Post
But doesn't this cause the same issue that is the #1 complaint in the US? That the rich get to see fine doctors and specialists with little wait time while the remainder of us are in a cattle line waiting for the scraps?
It's not a matter of waiting in a "cattle line", it is a matter of not even having a line to wait in. I have no problem with the wealthy getting "better" treatment, I only care about the minimum that is offered.

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Originally Posted by UltraVires View Post
This is something always overlooked in these Medicare threads.

I don't think you stated it entirely correct, though. Doctors take Medicare patients because that is who the vast majority of sick people are: old people. They can supplement their income by taking Medicare. They make their money on private pay clients through insurance reimbursement rates. As most costs are fixed, they are then able to make a little bit on the lower Medicare rates.

If everyone was on Medicare, you are right, they would definitely go out of business.
There are a number of savings involved as well. You don't have to waste time coding your bills for different insurance companies, you don't have to have a staff that deals with getting pre-approvals and remittances, and you don't have the problem of people who cannot or will not pay their bills.
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But to the thread, my response in post #2 was what I thought the answer was. If a plan is out there to cover everything, and I mean everything, absolutely free at the point of payment, paid for by a tremendous tax increase to boot, why would I want to pay for private insurance? What would it be doing for me?

If the new health care is so bad that people would rather pay for something that is already "free," then that seems like a bad plan.
What do you mean by "everything?" Do you mena private rooms with a personal 5 star chef? I have no problem with a wealthy person having their own room and their own culinary expert, so long as they can find a bed for me when I need it.
  #52  
Old 08-02-2019, 01:53 PM
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I would think that those things would (or at least should) be so relatively inexpensive in comparison with buying an insurance policy that insurance wouldn't be needed.

I mean, what are we talking about? An upgrade from baked steak to T-bone, or are we talking Gordon Ramsay sit down dining with fine wine (if your health permits)?
Realistically the sky is the limit. I don't understand why you think they would be relatively inexpensive. Imagine being in a ward with 6 patients behind curtains vs having your own spacious room with a nice marble shower. Massive difference in cost.

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Private rooms meaning the same room which usually houses 2 patients now houses one, or are we talking the Four Seasons?
I would think a range of options up to and including four seasons level.

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And wouldn't these things be inversely proportional to your length of stay? If I have a minor health issue, I won't be in the hospital long so a few nights wouldn't be worth buying a policy, just paying as you go. Conversely, if I am so sick I am in there long term, I probably won't be eating much or enjoying any extra amenities.
The insurance is just how employers would give this perk to employees. Health "insurance" now is more like a health maintenance plan anyway.

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And I've always thought that hospitals could be more profitable by offering extra amenities. I mean, I've spent several nights in hospitals visiting people and when I want to eat, I have the same shitty cafeteria food and have to drive to a hotel (or usually motel) not affiliated with the hospital down the road. It would seem to be that a hospital could be profitable by operating a hotel on the grounds with restaurant options.
This does exist to some extent now.
  #53  
Old 08-02-2019, 01:54 PM
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Yeah, this. Private Insurance performs some useful, if luxurious, options for those that can afford it.

A more 'hotel-like' in-patient experience, with nicer rooms and menus.
Shorter waiting times for non-urgent consultancy or surgery.
Additional procedures which may have limited or no coverage under the NHS.
So in the single example of real-world private insurance co-existing with UHC, it takes the form of what amounts to supplemental stuff.

That I could get behind; if someone's willing and able to pay to get a private room, then maybe there could be private healthcare insurance available to help pay. Or if you wanted some procedure that's not approved, or your doctor wants to prescribe you off-formulary medication, then private insurance could cover that.

Or even maybe to let people pay for more convenient surgery times or visit times... I wouldn't have a problem with that either.

After all, the point of UHC isn't to make it strictly fair and even, but rather to ensure that all residents get adequate health care, and aren't financially destroyed by extreme healthcare events.
  #54  
Old 08-02-2019, 01:54 PM
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From my understanding, Sanders (and others) want an expanded version of Medicare that would cover absolutely anything and everything with no deductibles and no copays. I think the only exception he said was for elective cosmetic surgery.

So, under such a plan, there would be no need for private insurance because, what is there to insure?
Faster cadillac service. Look both Canada and the UK have private insurance. There's no reason to dump it.

And for most supporters MFA means just that= Medicare for all. Not a new cost free super expensive system. Medicare, other than part A, has premiums. Affordable premiums, yes, but still they are there.
  #55  
Old 08-02-2019, 01:57 PM
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Disallowing people to opt out of the combined pool and form their own low risk pool means that those in the lower risk pool would pay more than they otherwise would.
How can this be, when nobody would be paying anything?
  #56  
Old 08-02-2019, 02:01 PM
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This would definitely be a potential problem and is the first reasonable criticism I've heard. This could be dealt with by legislation but it would come with extra cost to enforce it.
Well, there's also Medicare part C & D- "gap" and prescriptions. Both of which work very well (and profitably) for private insurers.

Also some people want and can afford private rooms, nurses, and the procedure done when they want it- sooner rather than later, and not during a planned vacation, for example.

If you can afford those, why not allow them to buy special insurance?
  #57  
Old 08-02-2019, 02:03 PM
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I am still not hearing any arguments for keeping Humana alive. I am quite interested in them, especially ones that aren't based on faith-based systems like "capitalism is always good" 'n stuff.
Why do you hate Humana?

Why couldnt they offer Gap insurance, drug or cadillac insurances?
  #58  
Old 08-02-2019, 02:06 PM
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Originally Posted by SanVito View Post
Yeah, this. Private Insurance performs some useful, if luxurious, options for those that can afford it.

A more 'hotel-like' in-patient experience, with nicer rooms and menus.
Shorter waiting times for non-urgent consultancy or surgery.
Additional procedures which may have limited or no coverage under the NHS.
Like birth control and abortions.

or is the plan that women have to seek out guys in alleys with coat hangers again?
  #59  
Old 08-02-2019, 02:10 PM
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The way that insurance is supposed to work is, you pay a fixed, predictable amount, so that if you suffer some calamity, you'll be able to afford it.

If that were the way that it actually worked, then there would be no problem in letting it continue to exist.

The way it usually actually works, though, is that you pay a fixed, predicable amount, and then if you suffer some calamity, the insurance company comes up with some damned fool excuse for why they don't have to pay out (the janitor who sweeps up the doctor's office is out-of-network or something), and now you're stuck with the cost of the calamity, and whatever you've already paid to the insurance company.
...
I have Kaiser and I have never had that issue, not once in 20 years. Before kaiser, I had one issue like that. One. (They didnt want to cover the specialist, even tho he was at their office, and I had no way of knowing he was out of network. Eventually we settled)
  #60  
Old 08-02-2019, 02:15 PM
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But again, a public option covers this. I'm with you on why a private healthcare only system is bad - what I don't understand is the need to proactively abolish it. If the free option is remotely decent, then sure as hell no one is gonna pay for it.
We, today, pay the govt for part B. You pay a private insurer for parts C & D.

Now, apparently Sanders and maybe warrens ideas are not in any sense "Medicare for all" but another totally free and extremely expensive plan they have no solid details on.
  #61  
Old 08-02-2019, 02:17 PM
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Well, there's also Medicare part C & D- "gap" and prescriptions. Both of which work very well (and profitably) for private insurers.

Also some people want and can afford private rooms, nurses, and the procedure done when they want it- sooner rather than later, and not during a planned vacation, for example.

If you can afford those, why not allow them to buy special insurance?
Because (and I can't believe I am taking THIS side) why should I have to wait 4 to 6 weeks for a procedure when a bed could be open sooner but for Scrooge McDuck taking up enough space in the hospital for 4 people?
  #62  
Old 08-02-2019, 02:18 PM
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But to the thread, my response in post #2 was what I thought the answer was. If a plan is out there to cover everything, and I mean everything, absolutely free at the point of payment, paid for by a tremendous tax increase to boot, why would I want to pay for private insurance? What would it be doing for me?

If the new health care is so bad that people would rather pay for something that is already "free," then that seems like a bad plan.
It depends on what the private insurance is for.

There is "complementary" insurance. That will pay for procedures and treatments that are covered under the UHC plan, over and above the statutory rates. The advantage of this has been mentioned before - you can jump to the head of a queue, doctors will prefer to treat you over other UHC-only patients because they make more money, etc. The objection to this kind of insurance is that it's not fair that the rich can buy their way to the head of the line. Complementary insurance is illegal in Canada, but is encouraged in Australia, both of whom have UHC. Go figure.

There is "supplementary" insurance, that covers things the UHC system won't. Elective cosmetic surgery has already been mentioned. There is also stuff like dental insurance, which is sort of the same thing. A system where "absolutely everything is covered" - you are correct, nobody would want or need it. But, suppose there is some drug or treatment for your condition that works, say, 10% better but costs five times as much. And the UHC plan says "no, we won't cover that - if you want treatment, you can use the cheaper drug and like it". There might be a market for insurance that covers that.

Saying No is difficult and uncomfortable in health care. Because, supposing we implement UHC but it only covers things the government thinks are cost-effective - limited numbers of experimental treatments, lower cost but marginally less effective drugs, etc.

Sooner rather than later, there will some cute little white kid with some obscure disease and an experimental treatment for it that costs $250K. Immediately the family and the media go to work with appeals ("Don't let little Justin die!") and they will set up a GoFundMe page and also go to work on the politicians, pointing out all the while that funding the treatment will cost the average taxpayer less than the price of a cup of coffee per day. And then the politicians who want to get re-elected get going on a bill, called the Justin Unpronounceable Disease Act, funding the treatment and rush it thru, and all the politicians who are not incumbent point to the politicians who are and mention in their campaign ads that they are in favor of dead children in order to save coffee money.

And then Justin gets the treatment and dies anyway, and the act authorizing payment for the treatment still remains, or Justin gets better and they double the funding.

Lather, rinse, repeat, and your cost savings from UHC suffers the death of a thousand cuts.

The only realistic solution to the cost of health care, especially in the US but also in Europe, is rationing. And that means saying, "No. We would rather let your grandma/cute kid/you die, because we would rather not spend the money."

That's not always going to be true. Lots of countries spend less on health care and have comparable or better outcomes. That's due to several factors - lifestyle, culture, the fact that a lot of health care spending doesn't affect outcomes all that much - but mostly it is due to culture, where people don't demand the level of health care they get in the US because they're used to not getting it.

Whether that can be brought off in the US is not clear - probably not for fifty years or so, even if we implement UHC. Witness the Medicare Sustainability Act, passed with the worthwhile intent of limiting growth in Medicare spending. Which, for seven years running and with bipartisan support, never reduced Medicare spending by a single penny. Then it was thrown out altogether.

And here we are, proposing Medicare for All because it will cut spending back and limit its future growth.

And this time, we mean it!

Regards,
Shodan
  #63  
Old 08-02-2019, 02:21 PM
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..
Current conversation on this topic tends to focus on the hypotheticals of "what if's". They are framed from a Right perspective - even your title to this thread has a Right-tilted framing - "abolish private insurance". Perhaps instead of asking why we want to "abolish private health insurance", perhaps we ought to frame the question as to why we want to "keep the current system"? ..
Well, isnt Medicare part of the current system? I would like to see Medicare for all. However, as you must know, two parts of Medicare are covered by private insurers.

I have grave doubts as to sanders plan, whatever the hell it is, since he gives no real specifics.

I want MFA, but I see no reason to ban private insurance also.
  #64  
Old 08-02-2019, 02:24 PM
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Because if there is private insurance, it would likely carve out the most profitable group of people, and exclude those that aren't profitable. What is left in the M4A program would be high cost individuals, making the overall program more expensive. By eliminating private insurance, the government would force those that have lower expected costs to subsidize others with higher expected costs.
...
Why couldnt there be the current gap and drug policies? Why not cadillac policies? I dont think anyone could "opt out" from MFA, so there is no chance at all of "private insurance carving out the most profitable group of people" since those people still would have to pay the extra taxes involved. Maybe they could skip part B, sure, like I do.
  #65  
Old 08-02-2019, 02:26 PM
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Because (and I can't believe I am taking THIS side) why should I have to wait 4 to 6 weeks for a procedure when a bed could be open sooner but for Scrooge McDuck taking up enough space in the hospital for 4 people?
Because the wealthy should not be monopolizing the resources. Without that wealthy person taking up their space, then a 6 week wait becomes a 5 week 4 day wait.

If the wealthy jumping the line or getting better treatment while others are no longer able to access those resources at all, as in the current system, that is a problem. That the wealthy get better treatment at only a slight detriment to others is perfectly acceptable.

Once again, this is not about making sure that everyone is treated equally, only that everyone is treated at a minimum, adequately.
  #66  
Old 08-02-2019, 02:26 PM
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...

People who are 70 can still pay for insurance, if they choose. They don't have to pay for Medicare.
....
Everyone who has earned income pays for medicare.
  #67  
Old 08-02-2019, 02:28 PM
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I love how they warn us of "rationing" in a public system.
Also would you rather have the people in charge of the rationing your healthcare see you as a voter they want to keep happy for the next election, or as a drain on their bottom line.
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Old 08-02-2019, 02:28 PM
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Because (and I can't believe I am taking THIS side) why should I have to wait 4 to 6 weeks for a procedure when a bed could be open sooner but for Scrooge McDuck taking up enough space in the hospital for 4 people?
Because Scrooges hospital isnt open for you, anyway. It's a private hospital.
  #69  
Old 08-02-2019, 02:28 PM
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Sooner rather than later, there will some cute little white kid with some obscure disease and an experimental treatment for it that costs $250K. Immediately the family and the media go to work with appeals ("Don't let little Justin die!") and they will set up a GoFundMe page and also go to work on the politicians, pointing out all the while that funding the treatment will cost the average taxpayer less than the price of a cup of coffee per day. And then the politicians who want to get re-elected get going on a bill, called the Justin Unpronounceable Disease Act, funding the treatment and rush it thru, and all the politicians who are not incumbent point to the politicians who are and mention in their campaign ads that they are in favor of dead children in order to save coffee money.
This is an important point, and although this is Elections, my question here is GQ.

How do other countries deal with such a thing? Does UHC cover absolutely anything, I mean the latest and greatest, we will spare no expense to save you? I'm not talking about catered food and posh rooms. I mean a scenario where Joe Q. Citizen has a terminal illness. But there is this very expensive treatment that may save his life, may kill him, but the most recent and best studies show modest improvement. Does the government pay? Will our government pay under any of the Dem plans?

If not, where is the cutoff? Only if it doesn't cost $X? Or if you aren't older than Y? Or if your likelihood of survival is above Z? Who determines it?
  #70  
Old 08-02-2019, 02:30 PM
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Originally Posted by k9bfriender View Post
Any pooling at all is people not paying commensurate to their risk. You will never have two people with exactly the same risks of health costs, much less a "pool". What you are advocating is getting rid of pooling altogether, and just paying it all on your own.
Of course it's not exactly, but actuaries can group people based on relative risk. The tighter the grouping, the more accurate the rating and thus premium in relation to risk.
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Faster cadillac service. Look both Canada and the UK have private insurance. There's no reason to dump it.
My understanding is that Canada doesn't allow private insurance for items that are covered in their UHC.
[/quote]Canadians can purchase supplemental private coverage for services that are not covered by the public plan, but cannot purchase private insurance for basic services. As CBC News points out, private health insurance is “a crucial part of the system,” and Canadians spent about $43.2 billion on private coverage in 2005. Private insurance covers “anything beyond what the public system will pay for. For instance, should you have to spend some time in the hospital, the public system will cover the cost of your bed in a ward, which usually has three other patients. If you want a private room, the extra charge will come out of your pocket, unless you have extended health coverage either through your employer or through a policy you have bought yourself.”

Basic services are covered by the government precisely because the large risk pools allow the government to negotiate cheaper rates with providers and control health care costs. The government fears, with good reason, that if Canadians can leave the purchasing pools, the government’s market power would diminish./quote]
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How can this be, when nobody would be paying anything?
Do you think Medicare doesn't require out of pocket spending?
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Old 08-02-2019, 02:35 PM
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This is an important point, and although this is Elections, my question here is GQ.

How do other countries deal with such a thing? Does UHC cover absolutely anything, I mean the latest and greatest, we will spare no expense to save you? I'm not talking about catered food and posh rooms. I mean a scenario where Joe Q. Citizen has a terminal illness. But there is this very expensive treatment that may save his life, may kill him, but the most recent and best studies show modest improvement. Does the government pay? Will our government pay under any of the Dem plans?

If not, where is the cutoff? Only if it doesn't cost $X? Or if you aren't older than Y? Or if your likelihood of survival is above Z? Who determines it?
There are many systems out there, but they pretty much have universal is that they have a list of covered procedures, and if a doctor orders that procedure, it is covered.

If there is a new, untested procedure, that may not be available, but often times, insurance isn't going to cover experimental medicine either, and their view of "experimental" is far more judgmental than a UHC's is.

Let me ask you this, who currently makes these decisions? Are you comfortable having your life in the hands of someone who sees the bottom line as the most important factor when considering whether or not to approve your treatment?
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Old 08-02-2019, 02:42 PM
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There are many systems out there, but they pretty much have universal is that they have a list of covered procedures, and if a doctor orders that procedure, it is covered.

If there is a new, untested procedure, that may not be available, but often times, insurance isn't going to cover experimental medicine either, and their view of "experimental" is far more judgmental than a UHC's is.

Let me ask you this, who currently makes these decisions? Are you comfortable having your life in the hands of someone who sees the bottom line as the most important factor when considering whether or not to approve your treatment?
Again, I was only asking and I still am. A "list of covered procedures" really doesn't answer the question because that list could be extensive or small.

But having worked in government before, I see little difference between a private company wanting to save money and a government bureaucrat wanting to show his or her higher ups how frugal the agency became once he or she "cut waste" from it. I think you have that everywhere, especially when the economy goes south. I'm sure that in a UHC you would have "little white Justin" stories like Shodan discussed.
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Old 08-02-2019, 02:42 PM
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Of course it's not exactly, but actuaries can group people based on relative risk. The tighter the grouping, the more accurate the rating and thus premium in relation to risk.
And the most accurate would be having the tight group of having no pool at all. It's a balance between accurately assessing risk, to ensure that everyone pays exactly their medical costs + overhead, vs spreading the risk around to make sure that no one ends up with a bill they cannot pay, or a life saving treatment they cannot have.

Towards the former basically gets rid of the idea of pools altogether, and the latter lends itself to suggesting a UHC.

If you work for a big corporation that offers healthcare, you are paying into a big pool. You are subsidizing others with more medical costs than you, and being subsidized by those with fewer. You are also subsidizing other employer's families, or childless employees are subsidizing yours.
  #74  
Old 08-02-2019, 02:44 PM
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Do you think Medicare doesn't require out of pocket spending?
I'm sure it does. But does the proposed MFA require out of pocket spending?
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Old 08-02-2019, 02:44 PM
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As CBC News points out, private health insurance is “a crucial part of the system,” and Canadians spent about $43.2 billion on private coverage in 2005. Private insurance covers “anything beyond what the public system will pay for. For instance, should you have to spend some time in the hospital, the public system will cover the cost of your bed in a ward, which usually has three other patients. If you want a private room, the extra charge will come out of your pocket, unless you have extended health coverage either through your employer or through a policy you have bought yourself.”
*snip. Color me unimpressed. A "ward" with four patients? I get better than that. The poorest people on Medicaid get better than that.
  #76  
Old 08-02-2019, 02:44 PM
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Quoth DrDeth:

I have Kaiser and I have never had that issue, not once in 20 years.
I'm glad to hear that you've never had a health calamity. Your experience is not relevant to those who have.

They're not going to pull all this nonsense for people going in for routine care, because that will lose them customers. They only pull it for the expensive customers, who they want to lose. When someone comes down with a chronic cancer or something, that's when they suddenly decide that that impacted hangnail back in third grade was a pre-existing condition and they don't have to cover anything.

Most people have never experienced this, because most people don't suffer calamitous health issues (that fact being why insurance is even possible). And most people don't pay attention to things that don't happen to them. So most people think that they're satisfied with their current insurance, because the nice lady on the phone sounds so friendly, and they didn't give any trouble about covering that routine checkup. But insurance that will stop covering you as soon as you get expensive isn't even insurance at all. And so most of those people who think they're satisfied with their insurance, don't even actually have insurance.
  #77  
Old 08-02-2019, 02:46 PM
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Of course it's not exactly, but actuaries can group people based on relative risk. The tighter the grouping, the more accurate the rating and thus premium in relation to risk.

My understanding is that Canada doesn't allow private insurance for items that are covered in their UHC.
.....
.... The government fears, with good reason, that if Canadians can leave the purchasing pools, the government’s market power would diminish./quote]

....
Yes, for basic "items that are covered in their UHC". However, GB does allaow it.

There's no risk of that, since all Canadians are taxed for it.
  #78  
Old 08-02-2019, 02:46 PM
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Again, I was only asking and I still am. A "list of covered procedures" really doesn't answer the question because that list could be extensive or small.

But having worked in government before, I see little difference between a private company wanting to save money and a government bureaucrat wanting to show his or her higher ups how frugal the agency became once he or she "cut waste" from it. I think you have that everywhere, especially when the economy goes south. I'm sure that in a UHC you would have "little white Justin" stories like Shodan discussed.
The covered lists are pretty extensive, and I'm certainly not going to even try to enumerate it. Basically, though, if it is a standard procedure, something that most doctors would agree is a reasonable treatment for a condition, it's covered.

Those higher ups would be horrified if one of their underlings caused their constituents to not be covered for procedures in the name of "cutting costs". We are the bosses of that hypothetical bureaucrat's higher ups, and we will not be all that impressed.

OTOH, this is pretty standard practice in the private insurance system that we have now. Denying procedures to save money gets you a bonus. If this is actually a concern of yours, then you would be advocating for a UHC system of some kind, MFA or otherwise.
  #79  
Old 08-02-2019, 02:50 PM
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Originally Posted by Chronos View Post
I'm glad to hear that you've never had a health calamity. Your experience is not relevant to those who have.

They're not going to pull all this nonsense for people going in for routine care, because that will lose them customers. They only pull it for the expensive customers, who they want to lose. When someone comes down with a chronic cancer or something, that's when they suddenly decide that that impacted hangnail back in third grade was a pre-existing condition and they don't have to cover anything.
....
That's how PPO's can work. That's not all all how HMO's work. I had cancer. Kaiser covered it, fast, easy and cheap. No such thing as "out of service' in a HMO.
  #80  
Old 08-02-2019, 02:51 PM
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To quote myself: "As far as I can tell there is no plan to directly abolish private insurance, but I can be wrong since I'm just going from the statements I can find on the presidential campaign websites."

I was wrong, as I admitted ahead of time I might be, and as you could have figured out from reading my whole post.
I did read your whole post which I why I quoted your ending jibe rather than your initial qualifier.
  #81  
Old 08-02-2019, 02:53 PM
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Here's what i found out- Sander's "plan" and maybe Warren's- is not in any way or form "Medicare for all". Calling it that is disingenuous. It's a new plan, with huge taxes and free for all. Nothing at all like Medicare.

It's socialized medicine at the point of a gun. That's exactly what America doesnt work.

Look, Great Britain's system works fine. They allow private insurance and still have a robust UHC that works.
  #82  
Old 08-02-2019, 02:55 PM
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I'm sure it does. But does the proposed MFA require out of pocket spending?
Whose? There are like 20 plans out there. Sanders Plans and warrens is not- even remotely- MFA. they are just using that term as Americans kinda like the idea.
  #83  
Old 08-02-2019, 02:58 PM
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Again, I was only asking and I still am. A "list of covered procedures" really doesn't answer the question because that list could be extensive or small.

But having worked in government before, I see little difference between a private company wanting to save money and a government bureaucrat wanting to show his or her higher ups how frugal the agency became once he or she "cut waste" from it. I think you have that everywhere, especially when the economy goes south. I'm sure that in a UHC you would have "little white Justin" stories like Shodan discussed.
There's a lot of difference. No politician or bureaucrat in a million years is going to describe de-listing a medical procedure as "cutting waste" anymore than they would claim such for cutting police or fire budgets. It would have to be defended on medical grounds. Budget does come into it, of course, but it comes down to stuff like "should we spend $3 million so an 85 yr old can live 3 more months". Yes, the dreaded rationing.

In the US, I can't imagine a Canada style system being implemented. Something like Germany or the UK that allows rich people to get quicker and more expansive coverage has to be included or it won't fly. Too many Americans think they might be rich someday and don't want to give up their daydream perks.
  #84  
Old 08-02-2019, 03:04 PM
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Whose? There are like 20 plans out there. Sanders Plans and warrens is not- even remotely- MFA. they are just using that term as Americans kinda like the idea.
Ok. Does the proposed Sanders plan, which I think is titled "The Medicare for All Act of 2019" require out of pocket expenses?

Also, I noticed the bill calls for a 2.2% tax on incomes under $200,000. Does this bill do away with the current Medicare Payroll Tax, or would we have to pay both?
  #85  
Old 08-02-2019, 03:06 PM
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There's a lot of difference. No politician or bureaucrat in a million years is going to describe de-listing a medical procedure as "cutting waste" anymore than they would claim such for cutting police or fire budgets. It would have to be defended on medical grounds. Budget does come into it, of course, but it comes down to stuff like "should we spend $3 million so an 85 yr old can live 3 more months". Yes, the dreaded rationing.
Grandma's shit outta luck because, according to Stanford scientists' inferences from kidney dialysis data, the US government values an extra year of human life at $129,000.
  #86  
Old 08-02-2019, 03:25 PM
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Grandma's shit outta luck because, according to Stanford scientists' inferences from kidney dialysis data, the US government values an extra year of human life at $129,000.
What is the private insurance industry's valuation?
  #87  
Old 08-02-2019, 04:29 PM
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We keep hearing from the capitalist-libertarian faction that private enterprise can do anything more efficiently and cheaply than government. So private enterprise should always be able to outcompete Medicare in the market, right?

Except it doesn't and can't.
The objective reality is that public health insurance is not only cheaper than private insurance, but people like it better than private insurance. The world libertarians inhabit on health care is the exact opposite of reality.

Medicare and medicaid have lower reimbursement and lower overhead, so they cost less. The amount of health care that would cost $100,000 from blue cross may only cost 70k if medicaid or medicare paid for it due to higher efficiency.

https://www.modernhealthcare.com/art...ers-study-says

https://content.gallup.com/origin/ga...4jxswxqvjg.png

https://www.healthaffairs.org/do/10....0.013390/full/

Just giving people medicaid is cheaper than giving them subisides for private insurance on the ACA exchanges. Right now it is 2k cheaper (5k vs 7k in subsidies) but that number will grow with time and will be 12k vs 8k by 2028.

https://slate.com/business/2018/08/m...exchanges.html

And medicaid has lower/no copays, deductibles, premiums, balance billing, out of network charges, etc. compared to private insurance.

You can get a 7k subsidy, along with 2k in premiums for a 9k a year private insurance plan. It'll have a 5k deductible, copays, balance billing and no out of network coverage.

Or for 5k you can get fully paid for medicaid with no copays or deductibles. No balance billing and no surprise bills.
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Last edited by Wesley Clark; 08-02-2019 at 04:29 PM.
  #88  
Old 08-02-2019, 04:57 PM
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The only realistic solution to the cost of health care, especially in the US but also in Europe, is rationing. And that means saying, "No. We would rather let your grandma/cute kid/you die, because we would rather not spend the money."

That's not always going to be true. Lots of countries spend less on health care and have comparable or better outcomes. That's due to several factors - lifestyle, culture, the fact that a lot of health care spending doesn't affect outcomes all that much - but mostly it is due to culture, where people don't demand the level of health care they get in the US because they're used to not getting it.




Shodan
Two points - Rare diseases are just that - rare. No rare disease, no matter how expensive, is going to be more than a blip when your pool is the US. Currently most states have special funds for children with cancer and other extremely expensive diseases and there's no discussion of getting rid of those.

There is a profound disconnect with your second premise. Why would anyone from another country demand more expensive care with worse outcomes from their medical establishment? I doubt the reason is because they aren't used to it.
  #89  
Old 08-02-2019, 05:16 PM
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I have grave doubts as to sanders plan, whatever the hell it is, since he gives no real specifics.
If only there was a "damn bill" written by Bernie Sanders that details exactly how Medicare For All would work. If only.

Get back to us after you've studied up on the subject and comprehend how it's intended to work.
  #90  
Old 08-02-2019, 05:23 PM
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Suppose you see a surgeon about whether or not you need an operation.
1. Private insurance--you see him tomorrow
2. Medicare for all--6 week delay for appointment

Surgeon says you need surgery immediately, sets up operation. If patient has Medicare for all pay for the operation then his private insurance has allowed him to jump the queue.

So with a private insurance option you would need complicated rules for a patient about switching between the two payment methods.
No you wouldn't. If I seek care that's covered by private insurance, I file a claim. Some services bill the insurer directly. Done and done.

None of this has anything to do with when I receive that care. If I need surgery or some other form of care immediately (and I've been in such a situation) I receive it immediately. Busted wrists can wait; busted spleens can't.
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  #91  
Old 08-02-2019, 05:24 PM
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I love how people who live in a world with $7,500 deductibles and $15,500 family max out of pocket, with "my insurance company denied X!" as a constant daily refrain, with the concept of co-insurance a thing, and doctors and clinics split into a bewildering array of networks...

I love how they warn us of "rationing" in a public system.
Do you want an acknowledgement that private insurance also involves rationing? It does. Here you go. Use my quote against any statement that insurance doesn't involve rationing, whether it's public or private. PM me if you need support that private insurance involves rationing.

My point is that if someone supports Medicare For All and objects to private insurance, they're either objecting to supplemental insurance, public-private combinations, or the current US private insurance system. The current system is obsolete with Medicare For All and I haven't heard of anyone proposing public-private combinations. So you've got my analysis on why someone would object to supplemental insurance.

If you want to make an argument that public insurance doesn't involve rationing, please make it.
  #92  
Old 08-02-2019, 05:43 PM
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What some call rationing, others call "triage." Trying so very hard to get all exercised over the idea, having spent a goodly number of years without health insurance nor enough money to pay to see a doctor should I have really needed it.
  #93  
Old 08-02-2019, 05:48 PM
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If you want to make an argument that public insurance doesn't involve rationing, please make it.
In a world without infinite resources, there will always be some form of rationing of some kind for any good or service.

The question is not whether MFA will create an infinite supply of healthcare, the question is, will it be rationed less than it currently is by the private system? Will there be better access and better outcomes? The answer to these, as demonstrated by the examples of other countries that have done so, is yes.

Are you demanding that MFA provides infinite healthcare before you would get onboard? If not, then why do you keep harping on this? If so, then you will never be satisfied by any proposal of any kind, and therefore, your opinion need not be courted.

What rationing do you see in the current medicare system that you are concerned will be expanded if the system grows to include everyone?

Last edited by k9bfriender; 08-02-2019 at 05:49 PM.
  #94  
Old 08-02-2019, 05:52 PM
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I mean, what are we talking about?
Dental care, opticians and eyeglasses, physical therapy, private diagnostic services, addiction treatment, mental health counselling, and preventative care. This is specific to UK supplemental insurance, and you're able to get all of the things I've listed on the NHS. However, many of them are means tested, and the others are limited. There genuinely is a tiered healthcare service for those able to afford private insurance, whether on their own, or through their employer. Whether or not that's a negative is a different question.
  #95  
Old 08-02-2019, 06:02 PM
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I suppose if those that opt out would still be forced to pay for a service they weren't using it would solve the adverse selection problem.

There would still probably be people who would be opposed to private insurance because they don't want anyone to get anything better than them.

Consider, Canada has banned much of private insurance, what are their reasons?
Canada bans private insurance from paying for publicly covered procedures. The basic reasoning is that allowing competition can hamstring the public system because it has some legal mandates that would decimate it in the open market. First remember, most doctors and hospitals are paid on a fee for service basis in Canada. The provinces pay the fees, they don't just give them a salary to work on whatever comes in.

Imagine the most profitable surgery is wart removal. So a smart doctor opens a wart removal clinic and sends all non-wart patients to the public doctor. That public doctor is now legally required to treat only the less profitable cases. Yes, the public doctor does have the advantage of patients not having to pay but there can be a sweet spot in the pricing that can mess up things. Lately though, recognizing that in some areas competition isn't an issue because the public system is at capacity, they've loosened some of things that can be privately done.

Last edited by CarnalK; 08-02-2019 at 06:02 PM.
  #96  
Old 08-02-2019, 06:17 PM
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This is an important point, and although this is Elections, my question here is GQ.

How do other countries deal with such a thing? Does UHC cover absolutely anything, I mean the latest and greatest, we will spare no expense to save you? I'm not talking about catered food and posh rooms. I mean a scenario where Joe Q. Citizen has a terminal illness. But there is this very expensive treatment that may save his life, may kill him, but the most recent and best studies show modest improvement. Does the government pay? Will our government pay under any of the Dem plans?

If not, where is the cutoff? Only if it doesn't cost $X? Or if you aren't older than Y? Or if your likelihood of survival is above Z? Who determines it?
I can only answer for the UK, but we have The National Institute for Health and Care Excellence.
https://www.nice.org.uk/

I think they do an outstanding job, but they do face objections from the little Justin supporters that Shodan described.
  #97  
Old 08-02-2019, 06:18 PM
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Because if there is private insurance, it would likely carve out the most profitable group of people, and exclude those that aren't profitable. What is left in the M4A program would be high cost individuals, making the overall program more expensive. By eliminating private insurance, the government would force those that have lower expected costs to subsidize others with higher expected costs.
But that's not necessarily what's happening; it's entirely possible that the 75 year-old man is in generally good condition and paying for some 22 year-old kid who got drunk and fell down some stairs. I think what you're trying to suggest is that those who are statistically less likely to have health problems would be effectively paying the same rate as those who are predicted to be less risky. You should be fine with that -- the risk pool that JohnT is talking about makes access to medical care affordable for both the low risk and the high risk individual. Better yet, you don't have to worry about whether the ambulance you rode in to the ER or the anesthesiologist who monitored you while you in surgery is "in network." You don't have to fight with private insurance companies over who's going to pay for that $50,000 bill you thought was covered. The reality is that until you actually need your private insurance, you never really know whether it covers you the way you think it does.

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If you are a person who is in the lower risk categories, like, age 24-40, non smoking, no previous health issues, you really don't cost much to insure.
You don't know that -- you actually may turn out to cost a LOT to insure. What you mean is that you are statistically less likely to be expensive. We're talking about probability, not actual costs.

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Why would you want to be pooled with 70 year old smokers with a history of heart disease and cancer? Eliminating private insurance forces you to throw in your lot with everyone else.
Because as a consumer the economics of using the health system are more predictable, as is the access, even if it's demonstrably slower in some cases.
  #98  
Old 08-02-2019, 07:02 PM
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I am still not hearing any arguments for keeping Humana alive. I am quite interested in them, especially ones that aren't based on faith-based systems like "capitalism is always good" 'n stuff.
I'll start with a cite for what Sanders' Medicare For All bill from April actually does. There's plenty of confusion because he used the terminology more loosely in his 2016 campaign. Some treat MFA as a synonym for UHC (Universal Health Care) in one of the models that's been deployed in most other developed economy democracies. It's not.

Some key quotes:
Quote:
The plan is significantly more generous than the single-payer plans run by America’s peer countries.
Quote:
What’s more, the Sanders plan does not subject consumers to any out-of-pocket spending on health aside from prescriptions drugs. This means there would be no charge when you go to the doctor, no copayments when you visit the emergency room. All those services would be covered fully by the universal Medicare plan.

This, too, is out of line with many international single-payer systems, which often require some payment for seeking most services.
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Medicare, employer coverage, and these other countries show that nearly every insurance scheme we’re familiar with covers a smaller set of benefits with more out-of-pocket spending on the part of citizens.
Quote:
The reason they went this way is clear: It’s cheaper to run a health plan with fewer benefits. The plan Sanders proposes has no analog among the single-payer systems that currently exist. By covering a more comprehensive set of benefits and asking no cost sharing of enrollees, it is likely to cost the government significantly more than programs other countries have adopted.
It will be a bit before I get to including insurance as part of the system. First let's look define the problem in terms of MFA as Sanders has actually proposed it.

MFA would probably be the most expensive per capita UHC plan in the world. We'll need to raise more tax revenue to pay for it than other countries with cheaper programs do. While there's some important details for specific tax changes generally orthodox economics would expect negative effects on the economy from significant tax increases. Simply looking at a sum of government and household expenditures excludes those costs. Sanders didn't introduce enough detail about funding to really evaluate what the dynamic effects will be. The Congressional Budget Office punted on even doing an in depth estimate of costs earlier this year. There's risk of slowing of the economy, or at least it's growth, as a result.

Medical care is relatively inelastic but not perfectly inelastic. (Cite) People really do consume more medical care when the cost to them is lower.* When the out of pocket cost is free, like in MFA, the evidence says that we should expect maximum demand and consumption. That will contribute to increasing costs even more in what is already likely to be the most expensive system in the world. That's not just an increased cost to the government system. It's an increased cost when you sum up all payers. We can reasonably be expected to consume more health care than other nations with UHC if we implement MFA as written. Increasing the total costs also feeds back to increasing the dynamic costs even more.

Now let's look at why UHC with a role for private insurance might be preferable to MFA:
- Systems that cover less and allow co-pays are able to make use of market forces to reduce health care consumption where it has limited or no aggregate benefit. (Needs based programs, carefully tailoring the co-pays, or both can limit the negative effects of the poorest skimping on important health care.) That's a real way to reduce the total costs of healthcare. That also reduces the associated shadow costs due to reducing the tax burden necessary for that more limited system. MFA specifically prohibits an important cost saving measure included in many UHC systems. As soon as we allow a co-pay system there's a natural market in place to provide varying levels of supplemental insurance for those that are least risk tolerant.
- Many UHC systems follow a tiered approach. They provide good health care to all. Those systems allow private providers so there's still a market to get better than standard care. That better care may simply be quicker or more convenient scheduling but it could also be better quality. It might be something like going to the Mayo clinic for cancer treatment. MFA leaves providing health care in private hands. It disallows insurance for a higher tier of care from those private organizations, though. That gap is another pretty natural insurance market. With insurance that higher level of care is accessible to more people; those who could afford to insure against group risk for that higher standard can't necessarily pay for it out of pocket. MFA is effectively reducing access to the best level of care to all but the wealthiest by creating a market but not allowing insurance in that market. The 1% can still pay for the best hospital in the nation or world. The middle to upper middle class household that could have afforded insurance for that higher tier, or could access it under their current plan, is probably priced out of that market.
- The impact on that highest level of care has potential side other effects. The US healthcare system underperforms in aggregate numbers. Our best providers are among the very best in the world. There's even medical tourism that comes to the US despite the high costs. Those sites also tend to be at the forefront of research and improving standards of care for the world. We should be very careful about limiting their market as a result of prohibiting insurance. Limiting the ability of world leading research hospitals is a potential issue for have that many high quality research hospitals. There are other ways to try and correct the damage we might inflict on them under MFA. Something like increasing direct government funding for their research activities might work. That's not in MFA, though. We shouldn't simply ignore the risk. By disallowing insurance we effectively cripple any two tiered system. That potentially slows medical care improvements for the entire world.

The net of effects and some of the details are important. Some of the potential negatives of not allowing insurance in a US UHC plan in a briefer form:
- increasing costs by maximizing consumption of health care
- limiting GDP growth due to increasing the revenue the government would need to raise
- less or no access to some of the best care providers in the nation/world for anyone who's not wealthy
- slowing of medical improvements for the world

Again that's potential and it's not net effects. When you are looking at net costs it's probably worth remembering not to compare against ACA. UHC w/insurance versus current ACA is an entirely different comparison. The question you asked was why we might still want to allow private insurance in a UHC system. Don't confuse the comparisons.

* A classic example is the person who goes to the doctor with a cold and tries to browbeat them for antibiotics. That's the kind of behavior we want to discourage in a healthcare system. It's simply wasteful for the majority of people. My sister lives in France. A couple years ago their system either enacted or was looking at enacting a 1 Euro co-pay for doctor visits that had been free. It wasn't a major source of funds but they were hoping it would serve as a behavioral economics nudge. Get people to open their wallets for even small payments and they stop to think whether it's worth it. France was trying to reduce wasteful doctor visits with a very small co-pay. MFA would not allow that.

Last edited by DinoR; 08-02-2019 at 07:05 PM.
  #99  
Old 08-02-2019, 07:13 PM
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Canada does not have copayments. Germany apparently abolished a 20 year experiment with copayments because, according to wikipedia:
Quote:
However, after research studies by the Forschungsinstitut zur Zukunft der Arbeit (Research Institute for the Future of Labor) showed the copayment system was ineffective in reducing doctor visits, it was voted out by the Bundestag in 2012.
But hey, what do the Germans know about efficiency?
  #100  
Old 08-02-2019, 07:19 PM
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If only there was a "damn bill" written by Bernie Sanders that details exactly how Medicare For All would work. If only.

Get back to us after you've studied up on the subject and comprehend how it's intended to work.
Thats a nice cite. But bills dont really lay out the plan so much in a few talking points.

But altho that is entitled "Medicare for all" - it ain't.
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